Central Administrative Tribunal - Cuttack
K Manoranjan Nayak vs Central Board Of Indirect Taxes A& ... on 2 May, 2025
1 O.A.No. 260/00720 of 2023
CENTRAL ADMINISTRATIVE TRIBUNAL
CUTTACK BENCH, CUTTACK
O.A.No. 260/00720 of 2023
Reserved on 24.04.2025 Pronounced on 02.05.2025
CORAM:
THE HON'BLE SHRI SUDHI RANJAN MISHRA, MEMBER (J)
K. Manoranjan Nayak, aged about 42 years, Son of
Late Purna Chandra Khora, a permanent resident
of At/Post-Sainagar, Dist-Malakangiri, Odisha, at
present working as Additional Commissioner,
GST & Central Excise, Central Revenue Building,
Rajaswa Vihar, Bhubaneswar, Dist. Khurda, PIN-
751 007, [Gr. A].
..... Applicant
For the Applicant : Mr. J.M.Pattnaik,
Mr. Jyoti Ranjan Behera, Counsel
-Versus-
Union of India represented through -
1. The Chairman, Central Board of Indirect Taxes
and Customs, Ministry of Finance, Department of
Revenue, North Block, New Delhi-110 001.
2. The Director General, Human Resource
Development, Central Board of Indirect Taxes &
Customs, Bhai Veer Singh Sahitya Sadan, 2nd &
3rd Floor, Bhai Veer Singh Marg, Gole Market,
New Delhi-110 001.
3. The Chief Commissioner, GST, Central Excise &
Customs, Bhubaneswar Zone, C.R.Building,
Rajaswa Vihar, Bhubaneswar-751007.
2 O.A.No. 260/00720 of 2023
4. The Commissioner (Audit), GST & Central Excise,
Bhubaneswar Audit Commissionerate, Rajaswa
Vihar, C.R.Building, Bhubaneswar, PIN-751 007.
.....Respondents
For the Respondents: Mr. B.Samantaray, Counsel
ORDER
SUDHI RANJAN MISHRA, MEMBER (J):
The case of the applicant in brief is that he joined as Assistant Commissioner in the Office of Central Excise, Customs & Service Tax, Bhubaneswar in the year 2012. Having faced pain and headache, he rushed the SCB Medical College & Hospital, Cuttack [SCBMCH], which is a Govt. Hospital, for his treatment. The treating physician of the SCBMCH after examination came to the conclusion that since the treatment required for the applicant is not available at SCBMCH placed the matter before the Medical Board for proper advise. The duly constituted Medical Board of the SCBMCH after thorough examination came to the conclusion that since the facilities for the treatment of the applicant is not available at SCBMCH to avoid delay in availing the treatment advised the applicant to avail the immediate specialized treatment at Christian Medical College, Vellore [CMC]. Copy of the 3 O.A.No. 260/00720 of 2023 report of the Medical Board of SCBMCH is placed on record at Annexure- A/1.
2. It is stated that due to financial difficulties, he could not immediately proceed to Vellore and remained under treatment with the Physicians available in the locality with hope to be cured. There having no development on his condition, after taking leave, he went to Vellore and reported at the CMC hospital. The treating Physician after examining his condition suggested for surgery after normalization of his high blood pressure and other problems. After due medication, he came back to Bhubaneswar. On 06.02.2018, he submitted application enclosing thereto all the papers of SCBMCH, Cuttack and CMC, Vellore requesting to allow him to be treated at CMC, Vellore and to avail financial advance/reimbursement. However, taking into consideration his unbearable pain and difficulties, he availed personal loan from SBI and HDFC Bank, Bhubaneswar and applied for leave on 21.03.2018 to proceed to Vellore for treatment, which was duly sanctioned. Accordingly, he went to CMC, Vellore accompanied by his wife as an attendant and reported at the hospital for his treatment. He remained at the CMC, Vellore for surgery from 22.03.2018 to 26.03.2018. He was 4 O.A.No. 260/00720 of 2023 discharged from the hospital on 26.03.2018 but remained there for few days on the advise of the hospital for therapy treatment at Vellore. The total cost claimed by the hospital and paid by him was Rs. 17,28,496.46. He came back to Bhubaneswar on 21.06.2018 and submitted application in proper form on 10.07.2018 enclosing thereto all necessary documents for reimbursement of the expenses incurred by him towards his treatment at the CGHS rate. In letter dated 22.11.2019, he was intimated that reimbursement for Cochlear Implant Surgery is permitted only after the request has been approved and recommended by a standing committee and since no such recommendation was obtained, his claim for reimbursement is not permissible. Thereafter, he submitted another application praying for sympathetic consideration and, having received no consideration, he again submitted an appeal on 22.10.2021 for sanction/reimbursement of medical expenses but he received no reply thereon also.
3. According to the applicant, the recommendation of the Committee would have been required had he been on the basis of the recommendation of the CGHS Wellness Centre. Since, the Surgery at CMC, Vellore was required to be undertaken on the recommendation of 5 O.A.No. 260/00720 of 2023 the duly constituted Medical Board of SCBMCH, which is a Govt. of Odisha entity, rejection of his claim for no recommendation of the Committee is bad in law. It is his case that in order to simplify the treatment procedure under CGHS, beneficiaries have been permitted to undergo treatment at any empanelled private hospital without the required of a referral (permission). The guidelines relied on by the respondents in the order of rejection nowhere states that an employee has to go for surgery after the recommendation of the Committee. It only provides that for reimbursement of the amount, matter to be placed before the Committee. Therefore, rejection of his claim without putting the same before the Committee is highly illegal and arbitrary.
4. Further case of the applicant is that Specialty Hospitals are established for treatment of specified ailments and services of Doctors specialized in a particular discipline are availed by patients only to ensure proper, required and safe treatment. It cannot be said that taking treatment in Specialty Hospital by itself would deprive a person to claim reimbursement solely on the ground that the said Hospital is not included in the Government Order or of that matter no prior approval was obtained. The real test must be the factum of treatment and the 6 O.A.No. 260/00720 of 2023 authority concerned should only ensure that the treatment has actually been undertaken on the basis of supportive documents/records duly certified by Doctors/Hospitals concerned. Once, it is established, the claim cannot be denied on technical grounds. In the instant case, respondents taking an inhuman approach, rejected his rightful claim, which needs to be struck down by the judicial intervention.
5. Next submission of the applicant is that the ground of rejection of his claim is hardly a satisfactory state of affairs. The authority cannot in a mechanical manner deprive an employee of his legitimate reimbursement. The Central Government Health Scheme (CGHS) was propounded with a purpose of providing health facility scheme to the central government employees so that they are not left without medical care. The treatment undertaken at CMC, Vellore on the recommendation of the Medical Board since such facility was not available in SCB Hospital, the reimbursement claim ought not to have been rejected in a mechanical way. Moreover, the law does not require that prior permission has to be taken in such situation where the treatment of the person is the prime and paramount consideration. The doctors did his 7 O.A.No. 260/00720 of 2023 operation and had implanted device having been felt essential, rejection of claim without placing the same before the Committee is bad in law.
6. Ld. Counsel for the applicant in support of his claim has also placed reliance on the decision of the Hon'ble Apex Court in the case of Shiva Kant Jha Vs Union Of India, AIR 2018 SC 1975, Paschim Banga Khet Mazdoorsamity & Ors vs State of West Bengal & Anr, AIR 1996 SC 2426, Kirloskar Brothers Ltd vs Employees' State Insurance Corpn, AIR 1996 SC 3261, as also the decision of the Co-ordinate Bench of Hyderabad in OA No. 385/2023 (K.Prakasam Vs ESI Corporation disposed of on 18.12.2023), OA 804/2022 (Y.Chandrasekhar Rao Vs UOI disposed of on 21.08.2023), in OA 864/2021 (Smt. M.lalitha Kumari Vs UOI & Ors. dated 18.11.2022) and by CAT, PB, New Delhi in OA No. 475/2022 (Narendra Kr. Gupta Vs. ICAR dated 13.03.2024).
7. The sum and substance of the objection raised by the respondents in their counter and highlighted by the Ld. Counsel for the respondents in course of hearing are that based on the recommendation of the Medical Board of SCBMCH, Cuttack, requiring the applicant to go to Christian Medical College (CMC), Vellore for proper treatment since the facilities are not available in SCBMCH and to avoid delay in availing the 8 O.A.No. 260/00720 of 2023 treatment, the applicant vide letter dated 06.02.2018 requested the competent authority to allow him to be treated at CMC, Vellore and avail financial advance/re-imbursement. Since the applicant is a CGHS beneficiary, he should have taken referral from CGHS Wellness Center as per the OM of MoH&FW dated 12.6.2019 whereas he applied Earned Leave (medical purpose) for 40 days w.e.f., 19.3.2018 to 27.4.2018, which was sanctioned by the competent authority and, subsequently, he extended his leave upto 20.06.2018.
8. On 10.7.2018, he submitted medical reimbursement claim of Rs. 17,28,496/-, which was incurred by him for Cochlear Implant & Auditory Verbal Therapy. Since the admissibility of the claim was not under CGHS rate or AIIMS rate, his claim was forwarded to CGHS vide office letter dated 08.02.2019. The Additional Director, CGHS, Bhubaneswar vide letter No. MRC/SERVICE/CGHS-BBSR/2019-4407 dated 19.02.2019 clarified that re-imbursement for Cochlear Implant & Auditory Verbal Therapy should be examined as per OM F. No.6- 469/2003-CGHS/R&H dated 12.06.2009. On examination of the case with reference to the OM dated 12.06.2009, it was noticed that the Cochlear Implant Surgery is to be allowed only in cases (1) where the 9 O.A.No. 260/00720 of 2023 selection criteria as laid down in Para-1 is fulfilled, (2) the Cochlear Implant Surgery should be allowed only in Govt. Hospitals/Centers having post operative rehabilitation (3) The re-imbursement for Cochlear Implant Surgery will be permitted only after the request has been approved and recommended by a standing Committee provided in the said OM. Hence, his claim was rejected and the reason of rejection was intimated to him vide letter dated 22.11.2019. Since, the claim of the applicant does not fulfill the conditions, rejection of his claim is well justified leading no interference on the same.
9. Having given attentive consideration to the points noted above, perused the records and communications made in this regard and placed on record including the OM dated 12.06.2009.
10. Significantly, the SCB Medical College and Hospital is a Govt. of Odisha entity; the Medical Board of the said Hospital after examining the condition of the applicant recommended him to go to CMC, Vellore for proper treatment and to avoid further delay since the facilities required for the purpose of particular treatment were not available in the said hospital; submission of application by the applicant on 06.02.2018 requesting the competent authority to allow him to be 10 O.A.No. 260/00720 of 2023 treated at CMC, Vellore and avail financial advance/re-imbursement; and, sanction of leave in his favour to go to CMC, Vellore for the treatment as per the recommendation of the Medical Board are not in dispute being admitted by the respondents.
11. I have gone through the GoI, MoHFW, OM dated 12.06.2009 wherein the provision for reimbursement of Cochlear Implant Surgery expense is permissible, however, subject to condition that the said Surgery is to be done in government hospital/centre having post operative rehabilitation and, for this purpose, prior permission from DGHS, New Delhi has to be obtained by the serving employees, who are CGHS beneficiaries. In the instant case, the applicant admittedly reported to the Govt. Hospital (SCBMCH, Cuttack) and the Medical Board of the said Govt. Hospital recommended him to go to CMC, Vellore to avoid delay as the said facility was not available in the Hospital. The applicant has also duly intimated the same to his authority on 06.02.2018 and the authority concerned had also sanctioned leave for taking treatment at CMC, Vellore. Thus, it was the duty of the respondents on receipt of the application dated 06.02.2018 either to send the same to the proper authorities seeking prior permission or to 11 O.A.No. 260/00720 of 2023 have intimated the applicant to seek such permission from the DGHS, New Delhi. But, no such action was taken by them. Fact remains that the applicant undertaken the treatment and submitted the bills duly authenticated by the CMC, Vellore. Therefore, the question arises as to whether on such technical grounds of not taking permission from DGHS, on the face of the facts stated above, the applicant can be denied his genuine and legitimate claim?
12. The relevant portion of the decision relied on by the applicant in the case of Shiva Kant Jha Vs Union of India, AIR 2018 SC 1975, is quoted below:
"13) It is a settled legal position that the Government employee during his life time or after his retirement is entitled to get the benefit of the medical facilities and no fetters can be placed on his rights. It is acceptable to common sense, that ultimate decision as to how a patient should be treated vests only with the Doctor, who is well versed and expert both on academic qualification and experience gained. Very little scope is left to the patient or his relative to decide as to the manner in which the ailment should be treated. Speciality Hospitals are established for treatment of specified ailments and services of Doctors specialized in a discipline are availed by patients only to ensure proper, required and safe treatment. Can it be said that taking treatment in Speciality Hospital by itself would deprive a person to claim reimbursement solely on the ground that the said Hospital is not included in the Government Order. The right to medical claim cannot be denied merely because the name of the hospital is not included in the Government Order. The real test must be the factum of treatment. Before any medical claim is 12 O.A.No. 260/00720 of 2023 honoured, the authorities are bound to ensure as to whether the claimant had actually taken treatment and the factum of treatment is supported by records duly certified by Doctors/Hospitals concerned. Once, it is established, the claim cannot be denied on technical grounds.
Clearly, in the present case, by taking a very inhuman approach, the officials of the CGHS have denied the grant of medical reimbursement in full to the petitioner forcing him to approach this Court.
14) This is hardly a satisfactory state of affairs. The relevant authorities are required to be more responsive and cannot in a mechanical manner deprive an employee of his legitimate reimbursement. The Central Government Health Scheme (CGHS) was propounded with a purpose of providing health facility scheme to the central government employees so that they are not left without medical care after retirement. It was in furtherance of the object of a welfare State, which must provide for such medical care that the scheme was brought in force. In the facts of the present case, it cannot be denied that the writ petitioner was admitted in the above said hospitals in emergency conditions. Moreover, the law does not require that prior permission has to be taken in such situation where the survival of the person is the prime consideration. The doctors did his operation and had implanted CRT-D device and have done so as one essential and timely. Though it is the claim of the respondent-State that the rates were exorbitant whereas the rates charged for such facility shall be only at the CGHS rates and that too after following a proper procedure given in the Circulars issued on time to time by the concerned Ministry, it also cannot be denied that the petitioner was taken to hospital under emergency conditions for survival of his life which requirement was above the sanctions and treatment in empanelled hospitals."
13. The relevant portion of the of the decision of the Hon'ble Apex Court in the case of Paschim Banga Khet Mazdoorsamity & Ors Vs 13 O.A.No. 260/00720 of 2023 State Of West Bengal & Anr, AIR 1996 SC 2426, reads as under:
"The Constitution envisages the establishment of a welfare state at the federal level as well as at the state level. In a welfare state the primary duty of the Government is to secure the welfare of the people. Providing adequate medical facilities for the people is an essential part of the obligations undertaken by the Government in a welfare state. The Government discharges this obligation by running hospitals and health centres which provide medical care to the person seeking to avail those facilities. Article 21 imposes an obligation on the State to safeguard the right to life of every person. Preservation of human life is thus of paramount importance. The Government hospitals run by the State and the medical officers employed therein are duty bound to extend medical assistance for preserving human life. Failure on the part of a Government hospital to provide timely medical treatment to a person in need of such treatment results in violation of his right to life guaranteed under Article 21."
14. The relevant portion of the decision of the Hon'ble Apex Court in the case of Kirloskar Brothers Ltd vs Employees' State Insurance Corpn, AIR 1996 SC 3261, is produced hereunder:
"In Consumer Education & Research Center & Ors. v. Union of India & Ors. [(1995) 3 SCC 42] a three-Judge Bench of this Court held that the jurisprudence of personhood or philosophy of the right to life envisaged in Article 21 of the Constitution enlarges its sweep to encompass human personality in its full blossom with invigorated health which is a wealth to the workmen to earn his livelihood, to sustain the dignity of person and to live a life with dignity and equality. The expression 'life' assured in Article 21 does not connote mere animal existence or continued drudgery through life. It has a much wider meaning which includes right to livelihood, better standard of living, hygienic conditions in the workplace and leisure facilities and opportunities to eliminate sickness and physical disability 14 O.A.No. 260/00720 of 2023 of the workmen. Health of the workmen enables him to enjoy the fruits of his labour, to keep him physically fit and mentally alert. Medical facilities, therefore, is a fundamental and human right to protect his health. In that case health insurance, while in service or after retirement was held to be a fundamental right and even private industries are enjoined to provide health insurance to the workman."
15. The Hon'ble Apex Court in the case of Vincent Vs. Union of India, (1987) 2 SCC 165, have held that the employer cannot deprive its employee of the full reimbursement of the amount on the premise of non-recognition of the hospital, Indraprastha Apollo Hospital. The Supreme Court approved the decision of the High Court of Madras in W.P.No.4980 of 2006 in the following words:
"In regard to the reasons as to the non-inclusion of the Hospital in Government Order for denial, this Court cannot brush aside the advancement in modern medical treatment. Specialty Hospitals are established for treatment for specified ailments and services of Doctors specialized in a discipline are availed by patients only to ensure proper, required and safe treatment. Can it be said that taking treatment in Specialty Hospital by itself would deprive the beneficial order of the Government, solely on the ground that the said Hospital is not included in the Government Order. It cannot be so, as the Government Order should be read keeping the purpose for which the same was issued."
16. The CAT, PB, New Delhi in the case of Narendra Kr. Gupta (supra) also by placing reliance on the decision of the Shiva Kanta Jha (supra) has allowed similar type of claim by holding that the claim cannot be denied on technical grounds. Similar view has also been taken by the 15 O.A.No. 260/00720 of 2023 CAT, Hyderabad in the cases of K.Prakasham (supra) and Y.Chandrasekhar Rao (supra) and in the case of Smt. M.lalitha Kumari (supra)
17. On examination of the case in hand, with reference to the law laid down by the Hon'ble Apex Court and the co-ordinate Benches of this Tribunal referred to above, the only irresistible conclusion would be that the rejection of the claim of the applicant on technical ground is not sustainable. In the said premises, the order of rejection dated 22.11.2019 is hereby quashed. The respondent Nos. 3 and 4 are hereby directed to entertain the reimbursement claim of the applicant; process the same; sanction and pay the expenses incurred by the applicant as per the CGHS rate within a period of 60 days from the date of receipt of a copy of this order.
18. In the result, this OA stands allowed to the extent stated above. There shall be no order as to costs.
(Sudhi Ranjan Mishra) Member (Judl.) csk