Telangana HC slams Centre for denying full COVID-19 mediclaim to retired govt employee, wife

‘Not an approach expected from employer’
The bench explicitly stated that the department’s approach was unacceptable, noting, “The denial of reimbursement of medical expenses by the department instead of taking action against the hospital which has overcharged the CGHS beneficiaries, is not an approach expected by the employer.”

The petition filed by the Union of India – represented by the Ministry of Information & Broadcasting, Prasar Bharati – challenged the CAT’s direction to grant the reimbursement to the former employee Y Adinarayana, who retired as an engineering assistant from Akashvani All India Radio, Hyderabad.

The case centres on a medical emergency that occurred during the height of the COVID-19 pandemic. The employee, a beneficiary of the Central Government Health Scheme (CGHS), was admitted as an inpatient in an “emergency condition” to Krishna Institute of Medical Sciences (KIMS) in Secunderabad. He was suffering from uncontrolled diabetes mellitus, hypertension, and bronchial asthma. The employee and his wife survived the ordeal and were discharged on April 8, 2021.

Subsequently, their hospital bills of Rs 21.39 lakh were reimbursed to the extent of Rs 3.47 lakh by the employer, and the balance claim was rejected, following which the employee approached the Tribunal.

The Union of India denied full reimbursement on two main grounds. First, that the hospital had charged rates exceeding the ceiling prescribed by the state government’s order Rt No.248, dated June 15, 2020. Second, that the employee and his wife had failed to inform the department about their hospitalisation and treatment at KIMS, despite being CGHS beneficiaries.

The Tribunal rejected the employer’s rigid application of rules, noting that the employee and his wife were admitted in an emergency situation and that “no one was there who could inform the department about their hospitalisation and treatment”. The Tribunal then directed the employer to reconsider and settle the claim of the employee with full reimbursement within one month.

‘Employer could proceed against hospital’
Upholding this view, the high court delivered strong remarks on the employer’s handling of the matter. The court observed that the COVID-19 outbreak was a monumental crisis, stating, it “presented such a grave situation where human lives were lost without any treatment in a matter of a few days.”

Critiquing the department’s response to the overcharging issue, the court ruled that the onus should not fall on the recovering employee. “Despite being a CGHS beneficiary, if the hospital charged above the ceiling rates, the employer could proceed against the hospital in question instead of denying the reimbursement to the employee, who had settled the claim with the hospital on being discharged.”

Based on these findings, the high court declared that it found “no reason to interfere” with the Tribunal’s order and consequently dismissed the writ petition. The dismissal mandates that the Centre must now honour the full medical reimbursement claim for the employee. The court did not impose any costs on the parties.