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Central Administrative Tribunal - Lucknow

Ram Krishna Srivastava vs Cghs on 22 November, 2024

CAT,Lucknow Bench            OA No. 332/00172 of 2023     Ram Krishna Srivastava Vs. U.O.I. &Ors.




                    CENTRAL ADMINISTRATIVE TRIBUNAL

                         LUCKNOW BENCH LUCKNOW




                    Original Application No.332/00172/2023



                                              Order reserved on: 18.10.2024

                                               Order pronounced on: 22.11.2024



  Hon'ble Mr. Pankaj Kumar, Member-Administrative

  Ram Krishna Srivastava S/o Sri Bishwanath Lal Srivastava, aged
  about 85 years, Superintendent (Retd.) Customs & Central Excise
  R/o 1/14/61 Hausilanagar, Modaha, Civil Lines Faizabad now
  Ayodhya.


                                                                            .....Applicant

  By Advocate: Shri Narsingh Narain Lal


                                  VERSUS



  1. Union of India, through the Secretary, Ministry of Health & Family
     Welfare, Nirman Bhawan, Maulana Azad Road, New Delhi.

  2. The Special Secretary and Director General, Central Government
     Health Scheme (CGHS), Nirman Bhawan, Maulana Azad Road, New
     Delhi.
  3. The Additional Director, Central Government Health Scheme
     (CGHS), B114-115 Vibhuti Khand, Gomtinagar, Lucknow-10.
  4. The Principal Commissioner Goods & Service Tax and Central
     Excise, 38, MG Marg, Allahabad Distt. Prayagraj.
  5. The Dy./Asstt. Commissioner Goods & Service Tax and Central
     Excise, Civil Lines, Faizabad Distt. Ayodhya-1.

  6.
                                                                      .....Respondents

  By Advocate: Smt. Prayagmati Gupta

                                        ORDER

Per Hon'ble Mr. Pankaj Kumar, Member-Administrative In this case relating to medical reimbursement, the applicant seeks the following reliefs:

CAT,Lucknow Bench OA No. 332/00172 of 2023 Ram Krishna Srivastava Vs. U.O.I. &Ors.

"a) To quash/set aside the order contained in letter dated 23.03.2023 (Annexure A1) passed by the respondent No. 3.

b) To direct the respondent No. 3 to forthwith sanction and reimburse medical claims of Rs. 1,34,682/- and Rs. 2,11,406/- along with interest.

c) To pass such further other order/direction as this Hon'ble Tribunal may deem just and proper in the interest of justice.

d) To allow the OA with cost."

2. The facts of the case are that the applicant, having retired from the post of Superintendent in Central Excise & Customs Department on 30.05.2000, has been residing in Faizabad, a non-CGHS station. He was in receipt of Fixed Medical Allowance (FMA, hereafter). He sent a request dated 23.08.2021 to the Commissioner GST & Central Excise, Allahabad for stopping FMA so that he could enroll in CGHS facility from Lucknow. The applicant's wife underwent medical treatment in two spells, i.e., from 13.10.2021 to 16.10.2021 and from 05.10.2022 to 07.10.2022. The applicant applied for CGHS facility in terms of office memorandum (OM, hereafter) dated 12.09.2022 issued by Ministry of Health & Family Welfare resulting in issue of CGHS card having validity from 17.11.2022 to November, 2024. Thereafter, vide letter dated 05.12.2022, the applicant filed two medical reimbursement claims of Rs. 2,11,406/- (for the period 13.10.2021 to 16.10.2021) and Rs.

1,34,682/- (for the period 05.10.2022 to 07.10.2022) in regard to the medical treatment of his wife with respondent no. 3. The medical reimbursement claim was not entertained vide order dated 23.03.2023. Aggrieved, the applicant has preferred this OA.

3. The applicant contends that OM dated 05.06.1998 of Ministry of Health & Family Welfare provides that pensioners should not be deprived of medical facilities from the Government in old age when they require them most. He came to know of OM dated 12.09.2022 in November, 2022. By that time the applicant believed that no CGHS facility is available to a pensioner who draws FMA and resides in a non Page 2 of 6 CAT,Lucknow Bench OA No. 332/00172 of 2023 Ram Krishna Srivastava Vs. U.O.I. &Ors. CGHS city. A conjoint reading of OMs dated 05.06.1998 and 12.09.2022 provides that medical reimbursement claims will be sanctioned after making the required subscription as per CGHS guidelines. By returning the medical claim, the respondents have discriminated between pensioners residing in non CGHS area and those in CGHS area. Further, the applicant attempted to join CGHS by making application dated 23.08.2021 to stop FMA, but it was not responded to. When the applicant submitted the medical claim, he had paid CGHS subscription complying with condition 1(iii) of OM dated 12.09.2022.

4. The respondents, on the other hand, emphasize that as per paragraph 1(iii) of OM dated 12.09.2022, retired officials have the option to avail FMA for OPD and CGHS for IPD treatments after making the required subscriptions as per CGHS guidelines. In the present case, the subscription for CGHS facility was made by the applicant after 12.09.2022 and, therefore, the cards having validity from 17.11.2022 to November, 2024 were issued. But, at the time of availing medical treatment, the applicant had not subscribed to CGHS facility and was drawing FMA. The applicant did not exercise option for CGHS facility in terms of OM dated 05.06.1998 after he retired.

5. Heard both the parties.

6.1 The approach for providing medical facilities to pensioners is outlined in OM dated 05.06.1998 of Ministry of Health & Family Welfare in the following manner:

"The undersigned is directed to refer to the Department of Pension and Pensioners' Welfare OM No. 45/74/97-PP & PW(C) dated 15.04.1997 on the above subject and to say that it has been decided by this Ministry that the pensioners should not be deprived of medical facilities from the Government in their old age when they require them most. This Ministry has, therefore, no objection to the extension of CS (MA) Rules to the Central Government pensioners residing in non-CGHS areas as recommended by the Pay Commission..."

CAT,Lucknow Bench OA No. 332/00172 of 2023 Ram Krishna Srivastava Vs. U.O.I. &Ors.

(emphasis supplied) 6.2 The OM dated 12.09.2022 provides as follows:

"Subject: Reimbursement of medical claims to pensioners under CS (MA) Rules, 1944 as directed by various CATs/Courts - reg. The undersigned is directed to say that as per Note-2 below Rule 2 of CS (MA) Rules, 1944, Retired Government officials are not covered thereunder.

However, as per extant CGHS guidelines, Central Government Pensioners residing in non-CGHS areas have the following options:

i. They can avail Fixed Medical Allowance (FMA) in lieu of OPD facilities under CGHS.

ii. They can also avail benefits of CGHS (OPD & IPD) by registering themselves in the nearby CGHS covered city after making the required subscription.

iii. They also have the option to avail FMA for OPD treatment and CGHS for IPD treatments after making the required subscriptions as per CGHS guidelines.

2. As Ministries/Departments of Government of India are requested to bring the contents of this OM to the notice of organization(s) under their administrative control for guidance and compliance thereof. Also, retiring Central Government employees may be made aware of the above rule position.

3. Court/CATs cases filed by pensioners may be defended by Ministries/Departments in the light of above rule position. No reference in this regard needs to be made to Ministry of Heath & Family Welfare for comments/clarification etc. thereon..."

(emphasis supplied) It is noted that prior to the above OM, an OM dated 29.09.2016 was issued in a similar vein, paragraph 2(b) of which provided that:

"b) Pensioners residing in non-CGHS areas:

1) They can avail Fixed Medical Allowance (FMA) @ Rs. 500/- per month.

2) They can also avail benefits of CGHS (OPD and IPD) by registering themselves in the nearest CGHS city after making the required subscription.

3) They also have the option to avail FMA, for OPD treatment and CGHS for IPD treatment after making the required subscriptions as per CGHS guidelines."

(emphasis supplied) 6.3 It is evident from the OM dated 05.06.1998 that it was the intention of the respondents to extend the Central Services (Medical Allowances) Rules, 1944 to pensioners in non-CGHS areas. The OM dated 29.09.2016 allows the option to avail IPD treatment under CGHS after making the required subscription. This option has been re- iterated vide OM dated 12.09.2022.

CAT,Lucknow Bench OA No. 332/00172 of 2023 Ram Krishna Srivastava Vs. U.O.I. &Ors. 6.4 In the instant case, it is noted that the applicant retired from service in the year 2000. 21 years later, he wrote letter dated 23.08.2021 for stopping FMA so that he could enrol as CGHS beneficiary. Admittedly, he paid the subscription only after coming to know about OM dated 12.09.2022 in November, 2022. The guidelines prescribe that treatment can be availed after making the required subscription and they have been in public domain prior to 2021, i.e., prior to the medical treatments claimed. Ignorance of the guidelines does not accrue any legal right to the applicant. The subscription having been made in November, 2022, the applicant cannot claim entitlement to re-imbursement for medical treatment availed period prior to it.

6.5 Learned counsel for the applicant has cited several judgments in support of the applicant's case. In B R Mehta vs Union of India & Ors 79 (1999) DLT 388 specific permission was obtained from Director General of Health Services, Haryana. The ingredient of approval or permission is missing in the applicant's case. In Union of India vs R Rangarajan 2009 (4) SLR 720, Hon'ble High Court of Madras declined to interfere with the order of the Tribunal which had the effect of abjuring the vice of discrimination between the retired Central Government employees who are covered under CGHS and their less fortunate brethren who after retirement have settled down in places far away from areas covered under CGHS scheme. In the instant case, as observed in paragraphs 6.1 to 6.3, the option to avail of CGHS IPD treatment is available to pensioners living in non-CGHS areas as well. Thus these cases are distinguishable from the applicant's case. 7.1 In view of the foregoing, the applicant is not entitled to the reliefs prayed for. This OA is dismissed, accordingly. 7.2 Pending MAs, if any, are also disposed of.

CAT,Lucknow Bench OA No. 332/00172 of 2023 Ram Krishna Srivastava Vs. U.O.I. &Ors. 7.3 The Parties shall bear their own costs.

                                                                      (Pankaj Kumar)
                                                                      Member (A)




Vidya Ben        Digitally signed by
                 Vidya Ben Waghela

Waghela          Date: 2024.11.22
                 15:28:58 +05'30'




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