Central Administrative Tribunal - Bangalore
Yanamandra Satya Prasad vs Space on 15 July, 2025
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O.A.No.170/00550/2022/CAT/BANGALORE
CENTRAL ADMINISTRATIVE TRIBUNAL
BANGALORE BENCH, BENGALURU
ORIGINAL APPLICATION NO.170/00550/2022
Order Reserved on: 27.06.2025
Date of Order: 15.07.2025
CORAM:
HON'BLE JUSTICE B. K. SHRIVASTAVA, MEMBER (J)
HON'BLE MR. SANTOSH MEHRA, MEMBER (A)
Mr. YANAMANDRA SATYA PRASAD,
Retd. DEPUTY CONTROLLER OF ACCOUNTS,
HEAVY WATER BOARD, DEPT. OF ATOMIC ENERGY,
AGED 66 YEARS,
S/o. LT. SHRI. YANAMANDRA NARASIMHAM,
FLAT No. D-1102, SUMADHURA,
EDEN GARDEN, DODDABANAHALLI,
1st MAIN ROAD,
Off: SATYA SAI BABA ASHRAMAM ROAD,
WHITEFILED, BENGALURU - 560067 ...Applicant
(By Advocate Mrs. Beena P.K.)
Vs.
1. Under Secretary to the Government of India,
Department of Space,
Antariksh Bhavan
New Bel Road,
Bengaluru - 560 231.
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2. The Chief Medical Officer,
ISRO Satellite Centre,
Department of Space,
HAL Airport Road,
Vimanapura Post,
Bengaluru - 560 017.
3. The Additional Secretary & Grievance Officer,
The Department of Space,
Antariksh Bhavan,
New Bel Road,
Bengaluru - 560 231.
4. Under Secretary,
Industrial Relations & Welfare,
Department of Atomic Energy,
Anushakti Bhavan,
Chhatrapati Shivaji Maharaj Marg,
Mumbai - 400 001.
5. Regional Director,
Atomic Minerals Directorate for
Exploration & Research,
Department of Atomic Energy,
Southern Region,
#2817, Gnana Bharathi Main Road,
Teachers Colony, Nagarabhavi,
Bengaluru - 560 072.
6. Assistant Personnel Officer,
Atomic Minerals Directorate for
Exploration & Research,
Department of Atomic Energy,
Southern Region,
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#2817, Gnana Bharathi Main Road,
Teachers Colony, Nagarabhavi,
Bengaluru - 560 072.
7. The Head, Medical Division,
BHABHA Atomic Research Centre Hospital,
Department of Atomic Energy,
Trombay, Mumbai - 400 094.
8. General Services Organisation,
Department of Atomic Energy,
CISF Road, Kalpakkam,
Kancheepuram District,
Tamil Nadu - 603 102. ...Respondents
(By Shri N. Amaresh, Sr. Panel Counsel)
ORDER
PER: MR. SANTOSH MEHRA, MEMBER (A)
In this OA, the applicant has asked for the following reliefs:
i. Direct the Respondents to reimburse the deficit medical claim amounting to Rs. 35,80,348/- (Rupees Thirty-Five Lakh Eighty Thousand Three Hundred Forty - Eight) along with 18% interest from the date of payment till the date of realization of the entire claim.
ii. Direct the Respondents to pay the Applicant compensation for the inconvenience and metal agony suffered by the Applicant due to the authorities being negligent towards their public duty. iii. Any other relief that the Tribunal may deem fit in the interest of justice, equity, and good conscience.
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O.A.No.170/00550/2022/CAT/BANGALORE The facts in nutshell are as follows:
1. The applicant served in the Department of Atomic Energy till his Superannuation in 30.06.2016. He was a subscriber of Life Membership of CONTRIBUTORY HEALTH SERVICES SCHEME (CHSS) which was provided by the Department of Space, a Government entity with which Department of Atomic Energy had an agreement. The applicant had serious pulmonary problems, for which he underwent treatment for a long time in the hospitals of the organisation, and also Empanelled Hospitals.
2. During the course of treatment, it was eventually found that he was suffering from Sarcoidosis. The prognosis was that he has to undergo double lung transplantation, to save his life. This surgical procedure required huge amount of money. There was long-term correspondence between the applicant and his organisation regarding medical reimbursement. Due to progressive deterioration of his condition, the applicant underwent double lung transplantation at APOLLO HOSPITAL Chennai, and subsequently submitted total medical bills amounting to Rs. 68,67,020/-. However, his organisation reimbursed him only to the extent of Rs. 30,76,184/-.
3. Dissatisfied with the reimbursement, the applicant approached this Tribunal in 24.01.2020, vide O.A No. 68/2020. This Tribunal directed the respondents to reconsider his claims. In compliance with the order of the Tribunal, his organisation ajay mudgal CAT ajay Bangalore 2025.07.18 mudgal 17:22:20 +05'30' 5 O.A.No.170/00550/2022/CAT/BANGALORE sanctioned him additional amount of Rs. 2,10,488/-.
Dissatisfied with the amount further sanctioned to him, the applicant has approached this Tribunal once again. Hence, this O.A.
4. The learned counsel for the applicant submits that the applicant is a retired Deputy Controller of Accounts, Department of Atomic Energy, and subscriber of Life Membership, Contributory Health Service Scheme, provided by the Department of Space.
5. The Applicant, aged 66 years, had earlier approached this Tribunal by way of O.A No. 68/2020, praying to direct the Respondents to consider the Applicant's Original Application and reimburse the medical claim amount of Rs. 39,90,836/- (Rupees Thirty-Nine Lakh Ninety Thousand Eight Hundred Thirty-Six Only) along with 18% interest till the date of payment and further to direct the Respondents to pay to the Applicant compensation for inconvenience and mental agony suffered by the Applicant due to the authorities being negligent towards their Public duty.
6. This Tribunal on 21.04.2022, disposed of the above mentioned OA No. 68/2020 without entering into the merits of the case with a direction to the Respondents' Competent Authority to decide the Applicant's claim in full within a period of 6 weeks.
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O.A.No.170/00550/2022/CAT/BANGALORE The Respondents on 29.07.2022 issued an order granting only a mere amount of Rs. 2,10,488/- (Rupees Two Lakh Ten Thousand Four Hundred Eighty-Eight Only) as against the claim amount of Rs. 39,90,836/- (Rupees Thirty-Nine Lakh Ninety Thousand Eight Hundred Thirty-Six Only).
7. Recollecting the sequence of events, the learned counsel for the applicant states that in 2004, while serving as an Assistant Accounts Officer at the Department of Construction Service and Estate Management, Mumbai the Applicant developed certain health issues, for which he consulted the Respondent No. 7. However, despite several follow-ups and medications, he developed severe health complications.
8. The Applicant was later referred to Dr. N. More of the Respondent No. 7 Hospital, who in turn reported that the Applicant was suffering from tuberculosis and prescribed medication. After a year's consultation, dissatisfied with the Applicant's progress, Dr. N. More referred him to Dr. Ashok Mahasur, Hinduja Hospital, an Empanelled Hospital of Respondent No. 7. Here, the Applicant was informed that he was wrongly diagnosed and medicated for tuberculosis, while, actually, he was suffering from an interstitial lung disease called 'Sarcoidosis'. Dr. Ashok Mahasur instructed Dr. N. More to stop tuberculosis treatment for the Applicant and ajay mudgal CAT ajay Bangalore 2025.07.18 mudgal 17:22:20 +05'30' 7 O.A.No.170/00550/2022/CAT/BANGALORE immediately conduct a lung biopsy to ascertain the existing condition. The Applicant underwent a lung biopsy, and the medical report dated 17.08.2004 confirmed that the Applicant was indeed, suffering from 'Sarcoidosis'.
9. Upon attaining superannuation in 2016, the Applicant subscribed for CHSS 'Life Membership' and he was assigned to Dr. R.S. Nagaraj, Medical Officer, for regular medical consultation and follow-up. Dr. R.S. Nagaraj reported that the Applicant's condition had deteriorated drastically and immediately referred him to Dr. Shivaraj, Pulmonologist, Columbia Asia Hospital, Whitefield, Bengaluru, for further diagnosis and treatment, who prescribed a portable oxygen concentrator. The treatment of the applicant continued under the Respondents' medical facilities for a long time, but there was progressive deterioration.
10. In September 2017, the Applicant was informed that his lungs were irrevocably damaged and he would require 'Double Lung Transplantation.' Dr. Shivaraj, in the letter dated 25.09.2017, referred the Applicant to Dr. Suresh Manickavel, Lung Transplant Specialist, Apollo Super Specialist Hospital, Chennai, for lung transplantation.
11. The Applicant got pre-lung examinations conducted and forwarded the reports to Dr. Suresh Manickavel. Based on the ajay mudgal CAT ajay Bangalore 2025.07.18 mudgal 17:22:20 +05'30' 8 O.A.No.170/00550/2022/CAT/BANGALORE medical reports, Dr. Suresh Manickavel informed that Applicant that the surgery would cost approximately Rs. 50,00,000/- (Rupees Fifty Lakh Only). Accordingly, the applicant addressed a letter dated 06.11.2017 to Respondent No. 2 and the Respondent No. 6.
12. Due to extreme urgency, the Applicant underwent pre-lung transplantation evaluation from 19.11.2017 to 22.11.2017, in the Apollo Hospital, Chennai, and incurred a medical expenditure of Rs. 2,82,309/- (Rupees Two Lakh Eighty-Two Thousand Three Hundred Nine Only). The pre-lung transplantation evaluation was crucial in determining the Applicant's condition and suitability to undergo double lung transplantation surgery.
13. The Respondent No. 1 issued a letter dated 21.11.2017 to the Respondent No. 6 stating that since the Lung Transplantation requested by the Applicant is not listed under the CHSS Schedule of Rates (SOR), the matter is referred to the Department of Medical Officers' Committee for consideration.
14. In the meantime, in view of deterioration of the condition of the applicant and based on the pre-lung transplantation reports and advice of Dr. Suresh Manickavel, the Applicant shifted to a place near the hospital to get his regular medical health check- up.
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15. The Respondent No. 1, in the letter dated 20.12.2017, communicated the recommendations of the Departmental Medical Officers' Committee requesting the Applicant to get the opinion of the Head of Department of Respiratory Medicine/Pulmonologist of a Government Institute and Pulmonologist of Victoria Hospital/Bowring Hospital, Bengaluru, before surgery and also to confirm to bear the cost of the treatment.
16. The Respondent No. 7 also asked the applicant for details of similar surgeries conducted at Apollo Hospital and details of other hospitals providing post-lung transplantation treatment.
17. The learned counsel for the applicant submits that though the Applicant's critical health condition required him to visit Apollo Hospital, Chennai, for immediate lung transplantation surgery by 20.12.2017, to comply with the conditions of the Respondent No. 1, the Applicant stayed back in his ailing condition to comply with all the requirements and produced the necessary medical certificates along with the enclosed letter dated 30.12.2017 addressed to the Respondent No. 1.
18. The Applicant, in the letter dated 08.01.2018, submitted the second medical claim to the Respondent No. 6 amounting to Rs. 97,520/- (Rupees Ninety-Seven Thousand Five Hundred and Twenty Only) which was incurred towards pre-lung ajay mudgal CAT ajay Bangalore 2025.07.18 mudgal 17:22:20 +05'30' 10 O.A.No.170/00550/2022/CAT/BANGALORE transplantation evaluations and also requested the reimbursement of the outstanding medical claim.
19. The learned counsel for the applicant submits that due to the Respondents' delay in approval of medical payments for double lung transplantation surgery, the Applicant was forced to utilise his entire retirement benefit amount of Rs. 23,00,000/- (Rupees Twenty-Three Lakh Only).
20. The learned counsel for the applicant further states that on 25/02/2018, the Applicant underwent double lung transplantation surgery in Apollo Hospital, Chennai. He was medically advised to stay in the hospital from 25/02/2018 to 05/03/2018. The Applicant incurred an expenditure of Rs. 50,19,050/- (Rupees Fifty Lakh Nineteen Thousand and Fifty Only) for the double lung transplantation surgery at Apollo Hospital, Chennai. The Applicant availed insurance from his son's employer amounting to Rs.3,00,000/- (Rupees Three Lakh Only) towards surgery cost. Thus, the total surgery cost incurred by the Applicant is Rs. 47,19,050/- (Rupees Forty- Seven Lakh Nineteen Thousand and Fifty Only). Subsequently, the Applicant had to undergo post-surgery maintenance from 10/03/2018 to 21/03/2018 and incurred additional expense of Rs.3,53,388/- (Rupees Three Lakh Fifty-Three Thousand Three Hundred Eighty-Eight Only).
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21. Following up on the medical bills submitted by the applicant, the Respondent No.1, in the letter dated 24/04/2018, intimated the Respondent No.6 and Respondent No.4 about the medical bills submitted by the Applicant for reimbursement.
22. In the letter dated 11/05/2018, Respondent No.4 communicated its principle approval to the Respondent No.1 towards medical expenses incurred by the Applicant by allowing six categories of medical expenses under the CHSS rates. On 17/08/2018, the Applicant addressed a follow-up letter to the Sub-Pay Officer, Directorate of Exploration and Research, Department of Atomic Energy, requesting immediate reimbursement of the medical claim. Meanwhile, the Respondent No.5, in the letter dated 10/09/2018, communicated the approval of payment in consultation with the Respondent No.8 amounting to Rs. 22,54,489/- (Rupees Twenty-Two Lakh Fifty-Four Thousand Four Hundred Eighty-Nine Only) against the submitted medical claim bill amount of Rs. 47,19,050/-(Rupees Forty-Seven Lakh Nineteen Thousand Fifty Only). The Respondent No.4 issued a letter dated 07/12/2018 to the Respondent No.6, in consultation with the Respondent No.7, stating that the authority has decided to finalize the rates according to the CHSS.
23. The Applicant, with a heavy heart, addressed a letter dated 20/12/2018 to the Respondent No.3 explaining about the high-
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O.A.No.170/00550/2022/CAT/BANGALORE profile surgery and the cost incurred for conducting the surgery on such short notice. The Applicant, in the letter, requested the officers to re-examine the medical claims and reimburse the deficit amount as soon as possible. The Applicant wrote several representations to the Respondents to re-examine and reimburse the medical expenses Incurred towards pre-lung transplantation tests, double lung transplantation surgery, and post-lung transplantation recovery.
24. In response, the Respondent No. 5 issued a letter dated 06/03/2019 to the Respondent No.4 sanctioning an amount of Rs. 8,21,695/- (Rupees Eight Lakh Twenty-One Thousand Six Hundred Ninety-Five Only) against the claim amount of Rs. 17,68,141/- (Rupees Seventeen lakh Sixty-Eight Thousand One Hundred Forty-One Only) submitted by the Applicant towards post-surgery expenditure.
25. Aggrieved by the limited amount sanctioned by the Respondents, the Applicant addressed a letter dated 09/05/2019 to the Secretary and Chairman, Atomic Energy Commission, Department of Atomic Energy, Mumbai, requesting for reimbursement of the balance payment of Rs. 37,90,836/- (Thirty-Seven Lakh Ninety Thousand Eight Hundred Thirty-Six Only) against his total claim of Rs. 68,67,020/- (Rupees Sixty- Eight Lakh Sixty-Seven Thousand Twenty Only). In reply to ajay mudgal CAT ajay Bangalore 2025.07.18 mudgal 17:22:20 +05'30' 13 O.A.No.170/00550/2022/CAT/BANGALORE the Applicant's letter dated 09/05/2019, the Respondent No.4 issued a letter dated 19/08/2019 stating, "Your request has been examined in this Department in consultation with Medical Division, Bhabha Atomic Research Centre (BARC) and it competent authority in the Department has been decided to maintain status quo in the matter."
26. The learned counsel for the Applicant states that the applicant is a life member of CHSS and suffered from Sarcoidosis. Since the said disease is not listed in the CHSS, the Respondents have approved the reimbursement amount by scrutinising under different CHSS rates. The Respondents have not considered the nature of the disease and the cost of such treatment. The wrongful diagnosis by Respondent No.7 in the early stage is the prime reason for deterioration of the Applicant's medical condition. The Applicant, having attained superannuation in 2016 and receiving a monthly pension of Rs.30,142/- (Rupees Thirty Thousand One Hundred and Forty-Two Only), and cannot afford such heavy expenditure. Hence, it is the duty of the Respondents under the CHSS to provide complete financial assistance to the subscribed members, especially when the treatment is taken from an empanelled Hospital under the recommendation of the empanelled Doctor.
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27. The learned counsel for the Applicant avers that in reply to the Right to Information enquiry made by the Applicant on 30/10/2019, the Central Public Information Officer of the Respondent No.8 in the letter dated 22/11/2019, stated that there are no specific provisions made in the CHSS Rules of the Respondent No.3 for lung transplantation. It further mentioned that prior to the Applicant, another patient had undergone heart and double lung transplantation in 2014 and an amount of Rs. 36,42,449/-(Rupees Thirty-Six Lakh Forty-Two Thousand Four Hundred and Forty-Nine Only) was paid by the Respondent No.8 to the Apollo Hospital, Chennai.
28. The learned counsel for the Applicant asserts that the applicant, a member of the CHSS scheme of the Respondents, is eligible is entire claim amount along with interest and compensation, which is tabulated as below:-
S. Date of Purpose Amt. paid by Amt. sanctioned by the No. Bill the Applicant Respondent
1. 22/11/2017 Pre- Lung Rs. 2,82,309/- Nil Transplantation Expenditure
2. 04/01/2018 Same as above. Rs. 97,520/- Nil ajay mudgal CAT ajay Bangalore 2025.07.18 mudgal 17:22:20 +05'30' 15 O.A.No.170/00550/2022/CAT/BANGALORE
3. 05/03/2018 Lung Rs. 47,19,050/- Rs. 22,54,489/-
Transplantation Expenditure
4. 21/03/2018 Post - Lung Rs. 3,53,388/- Rs. 2,23,454/-
Transplantation Expenditure
5. 11/04/2018 Same as above Rs.6,29,691/- Rs.3,77,580/-
6. 02/06/2018 Same as above Rs.41,930/- Rs.21,479/-
7. 06/06/2018 Same as above Rs.2,08,832/- Rs.1,85,682
8. 10/07/2018 Same as above Rs.90,300/- Rs. 13,500/-
9. 14/07/2018 Same as above Rs. 4,44,000/- Nil TOTAL Rs.68,67,020/- Rs.30,76,184/- Total balance to be paid to the Rs.37,90,836/- Applicant, excluding the interest amount. (before the Initial O.A)
29. The learned counsel for the Applicant argues that a Technical Standing Committee (TSC) was constituted by the Respondent's Competent Authority to review the Applicant's Claim, which made certain observations regarding the Applicant's Claim ajay mudgal CAT ajay Bangalore 2025.07.18 mudgal 17:22:20 +05'30' 16 O.A.No.170/00550/2022/CAT/BANGALORE without even considering the complexity of the surgery and the requirement for specialized treatment. The Technical Committee had wrongly observed that the Applicant's case was an 'Elective Surgery' rather than an 'Emergency Surgery'. According to the learned counsel for the Applicant, the Applicant is a member of the CHSS Scheme and has proceeded with the lung transplantation with the consent of the Respondents and the procedures suggested by them, including the evaluation from an empanelled Victoria Hospital in Bengaluru. The Respondents, without considering the above facts and documents, have unilaterally and arbitrarily reached the conclusion that Applicant is eligible only for a sum less than 50% of the medical expenses incurred. Therefore, the Respondents are legally bound to reimburse the entire medical claim rather than sanction a measly amount to the Applicant.
30. According to the learned counsel for the Applicant, the Respondents ought to have considered that the scheme is for the benefit of the Pensioners, and the Respondents are expected to give humane and sympathetic treatment to their Pensioners. Non-application of their scheme for reimbursement of medical expenses is against the provision of the scheme formulated by the Respondents. The Respondents' actions clearly defeat the purpose and objective CHSS scheme. The Applicant is eligible ajay mudgal CAT ajay Bangalore 2025.07.18 mudgal 17:22:20 +05'30' 17 O.A.No.170/00550/2022/CAT/BANGALORE under Clause 6.3 of the CHSS scheme, which was denied to this Applicant without any valid reasons.
31. The learned counsel for the Applicant asserts that as mentioned in clause 9.1 of the CHSS Scheme, the Applicant received treatment in a specialised empanelled hospital upon referral from the authorised empanelled Medical Officer of the Respondents. The Respondents ought to have considered that in 2014, a similar case for reimbursement of a medical claim amounting to Rs. 36,42,449/- (Rupees Thirty-Six Lakh Forty- Two Thousand Four Hundred and Forty-Nine Only), was done by the Respondents. The Respondents have wrongly stated that the procedure was an elective surgery rather than an emergency surgery. The reimbursement is based on MOU rates with the empanelled hospital (Apollo Hospital), which is highly contradictory, especially given that the Apollo Hospital/Doctor is an empanelled hospital of the Respondents.
32. The learned counsel for the Applicant, in support of his above arguments, has cited several judgements of the Hon'ble Supreme Court of India and different High Courts. Insisting that even though the rate charged by the Apollo Hospital were very high, the applicant had no option but to get the lung transplantation done over there, in view of the threat to life of ajay mudgal CAT ajay Bangalore 2025.07.18 mudgal 17:22:20 +05'30' 18 O.A.No.170/00550/2022/CAT/BANGALORE the applicant. Furthermore, the Apollo Hospital is one of the empanelled hospitals, under CHSS.
Emphasising that just because a disease is not covered in the CHSS Schedule of Rates for Diseases and procedures, the treatment cannot be denied, the learned counsel for the applicant has cited the following judgements:
A. In the case of the Director, Directorate of Medical & Rural Health Services and Ors. Vs. J. Margaret German Leema and Ors. decided on 15.04.2024 by Hon'ble High Court of Madras in W.A. (MD). No. 394 of 2024 and CMP (MD) No. 3516 of 2024, the court states as follows:-
"Para 23. A perusal of the affidavit indicates that due to serious medical condition, the petitioner's husband has been admitted and he was in hospital for nearly 66 days. As per the judgment of the Division Bench of this cited supra (Kulasekarapandian's case), merely because the Government has not incorporated a particular disease in the Government Order, the same cannot be considered to be a treatment for which the reimbursement is not available."
B. It is asserted by the learned counsel for the Applicant that it is the respondents who had empaneled Apollo Hospital and the applicant had complied with all the requirements and directions of the respondents, before going for the surgery. In this regard, he has placed reliance on the judgment in the case of Randeep Kumar Rana v. Union of India & Ors. decided by Hon'ble Delhi High Court in W.P (c) No. 2464/2003 on 29.04.2004. In this case the Court held as follows:-
ajay mudgal CAT ajay Bangalore 2025.07.18 mudgal 17:22:20 +05'30' 19 O.A.No.170/00550/2022/CAT/BANGALORE "Para 5. We have given our careful considerations to the arguments advanced by learned counsel for both the parties. It is not denied that the treatment taken at Escorts Hospital was pursuant to the recommendation made by the Safdarjung Hospital which is a Government hospital. Naturally, when a small child is to be treated for Ventrical Septal Defect involving open heart surgery, a specialised hospital and its services are required. Therefore, once the respondent themselves have recommended the treatment to be taken by the Escorts Hospital, they cannot deny the full reimbursement on the basis that the charges incurred by the petitioner over and above the package rate which the respondent has agreed with the said hospital cannot be reimbursed. At page 12 of the paper-book there is a letter conveying permission by the respondent to the petitioner to undertake specialised treatment from recognised private diagnostic centre. There is another letter of the respondent at pages 22-23 of the paper-book in which it has been admitted that Escorts Heart Institute and Research Centre was also one of the hospitals which the petitioner was entitled for treatment. Now we come to the plea which has been taken by the respondent in the counter affidavit. It has been contended in para 11 of the counter affidavit that it is the duty of the citizens to see and ensure that such recognised hospital do not charge excess of the package rates. How a citizen can ensure that a hospital does not charge over and above the package rate? The power to lay down guidelines is with the respondent. A citizen is a mere spectator to ajay mudgal CAT ajay Bangalore 2025.07.18 mudgal 17:22:20 +05'30' 20 O.A.No.170/00550/2022/CAT/BANGALORE what State authority do and decide. If the hospital has charged over and above the package rate, the respondent is under an obligation to pay to such charges as the petitioner has incurred over package rates at the first instance and if in law state can recover from the hospital concerned, they may do so but they cannot deny their liability to pay to the Government employee who is entitled for medical reimbursement.
Para 6. We do not see any merit in the submission of the respondent. We direct the respondent to reimburse the full amount of Rs. 2,09,501/- after taking into consideration the amount of Rs. 1,42,736/- which has already been paid to the petitioner. The balance amount be reimbursed within a period of four weeks. Petition stands allowed. Rule is made absolute."
C. Furthermore, the learned counsel for the applicant also invites our attention to several other Hon'ble Supreme Court and High Court judgments, wherein the contentions of the applicants have been upheld on grounds of:
a. Treatment/surgery without prior approval due to urgency/emergency in view of threat to life. b. Treatment in a non-empaneled hospital due to emergency or requirement of specialized treatment. c. Payment of charges higher than the Government prescribed rates.
D. Some of the cases cited by the learned counsel for the Applicant in this regard are as follows: i. Shri Prakash Chand v. Union of India & Ors., decided on 23 January 2007 by the Delhi CAT (Principal Bench), ajay mudgal CAT ajay Bangalore 2025.07.18 mudgal 17:22:20 +05'30' 21 O.A.No.170/00550/2022/CAT/BANGALORE reported at (2007) 3 SLJ 312 CAT. Relevant portions are as follows:-
"Para 22. In a catena of cases various Courts have laid down the following general principles for reimbursement of medical expenses incurred by Government servants, who undergo treatment in private hospitals:
(i) It is now settled law that right to health is integral to right to life.
(ii) A welfare State like India is bound to provide the basic requirements of its citizens. Health care facility is an integral part of the same and the CGHS has been established for the benefit of the Central Government employees. Even retired Government employees should not be left out of the purview of medical care.
(iii) If the Government servant has suffered an ailment which requires treatment at a specialized approved hospital and, on reference, the Government servant has undergone such tixaunent therein, it is the duty of the State to bear the expenditure incurred by the Government servant. Expenditure thus incurred requires to be reimbursed by the State to the employee.
(iv) The mismatch between the rates charged by the approved hospitals and the rates approved by the Government works always to the disadvantage of the patient. What was fair and reasonable in 1996 or 1999, when the rates apparently had some nexus with the then (current) rates has ceased to be so.
(v) The cost of medical treatment has been rising over a period of time and Government cannot deny the actual reimbursement from a Hospital recognized by it for ajay mudgal CAT ajay Bangalore 2025.07.18 mudgal 17:22:20 +05'30' 22 O.A.No.170/00550/2022/CAT/BANGALORE treatment on the basis of applying the rates as per the orders issued previously. It would, therefore, be appropriate to update the approved rates on an annual or, at least, biennial basis.
vi) It is not the duty of the citizen to ensure that recognized hospitals do not charge in excess of the package rates.
(vii) The Government was obliged to grant ex post facto sanction in case an employee requires a speciality treatment and there is a nature of emergency involved.
In such a situation, treatment in a non-recognized hospital and non-observance of prescribed procedure have to be condoned.
Para 23. As regards the judgment of the Hon'ble Supreme Court in State of Punjab and Ors. v. Ram Lubhaya Bagga etc. (supra), cited by the respondents, it has been considered in several of the judgments cited above. Thus, in the case of M.G. Mahindru v. Union of India and Anr. (supra) the following ruling was given:
"There cannot be any dispute with regard to the ratio laid down by the Supreme Court in State of Punjab v. Ram Lubhaya Bagga's case (supra). In that case the petitioner challenged the policy of the Government with regard to fixation of allowances. In that case no recommendation was made by the CGHS for getting the treatment from a private hospital. As far as the case in hand is concerned, it is the Government Hospital, namely, RML Hospital which has recommended the case of the petitioner for a specialized treatment by a ajay mudgal CAT ajay Bangalore 2025.07.18 mudgal 17:22:20 +05'30' 23 O.A.No.170/00550/2022/CAT/BANGALORE speciality hospital, which is on the approved list of CGHS. When the respondents themselves have recommended the case of the petitioner for getting treatment at a speciality hospital, to deny the benefit of giving full reimbursement would be contrary to the grant of medical facilities to a retired Government servant, if he cannot actually avail of the same. If the Government Hospital did not have the facility for giving treatment like the one which was required to be given to the petitioner, then it was an obligation on the part of the respondents to have reimbursed the total amount paid to the said hospital. Following the ratio laid down in the State of Punjab and Ors. v. Mohinder Singh Chawla's case (supra), I direct the respondents to reimburse the amount of Rs. 80,620/- to the petitioner within a period of four weeks."
ii. Shiva Kant Jha vs. Union of India is (2018) 16 SCC 187:
The Court held as follows:-
Procedure for Medical Reimbursement Claim (MRC) in Central Government Health Scheme (CGHS) "Para 7 ....
...(c) The CMO (R&H) processes the MRC as per CGHS Rates. If CGHS rates are not available, reimbursement is considered at AIIMS rates. And if AIIMS rates are also not available, the reimbursement is made as per actual rates.....
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O.A.No.170/00550/2022/CAT/BANGALORE Para 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 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.
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2025.07.18
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O.A.No.170/00550/2022/CAT/BANGALORE Para 14..
... 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.
Para 15......
In the facts and circumstances of the case, we are of opinion that the treatment of the petitioner in non- empanelled hospital was genuine because there was no option left with him at the relevant time. We, therefore, direct the respondent-State to pay the balance amount of ajay mudgal CAT ajay Bangalore 2025.07.18 mudgal 17:22:20 +05'30' 26 O.A.No.170/00550/2022/CAT/BANGALORE Rs. 4,99,555/- to the writ petitioner. We also make it clear that the said decision is confined to this case only."
iii. Anirudh Prataprai Nansi v. Union of India & Ors., 2025 LiveLaw (Bom) 206 (DB), on 06.06.2025 by the Hon'ble High Court of Bombay, held as thus:-
"4. The issue which arises for consideration is whether in the inescapable and pressing situation the petitioner, having undergone a heart transplant at a private hospital, could the petitioner be denied and/or not given full reimbursement of the medical expenses incurred by him for such major treatment. The question is also as to whether the rigors of normal rule of medical reimbursement should make a way for the case to be considered as a special case, for grant of full reimbursement. This, more particularly, as a heart transplant surgery is not walk-in category of surgery. It 6 June, 2025 requires availability of the organ and the specialized transplant facilities and a team of experts to perform the surgery. This is certainly not available or feasible in many hospitals. Also a retired Central Government servant whether can be discouraged and/or forego and/or not have a heart transplant merely because he is likely to face financial difficulties for non-
reimbursement of the expenditure which would be incurred, is also a question which needs to be pondered. More particularly considering such situations on the touchstone of the Constitutional guarantee of right to life, ajay mudgal CAT ajay Bangalore 2025.07.18 mudgal 17:22:20 +05'30' 27 O.A.No.170/00550/2022/CAT/BANGALORE which includes right to health and certainly right to avail of treatment, necessary to save one's life.
40. It also cannot be that the rules governing reimbursement are sacrosanct and nothing outside the rules in exceptional/special cases and especially deserving cases, can be considered for reimbursement by the Central Government. It would not require elaboration that in such matters it is an accepted position that there is a free play in the joints and such category of cases are required to be considered on their merits. A case to case legitimate decision protecting the fundamental rights is expected to be taken by the concerned officers. Such powers are conferred only to be utilized and more particularly when there is a need to exercise such powers not only to protect the fundamental rights but right to life and right to livelihood. Thus, apart from the Office Memorandum dated 15 July 2014 providing for relaxation, the High Power Committee even otherwise could exercise such powers of relaxation and in such deserving case, exercise its discretion to award full medical reimbursement."
33. Finally, the learned counsel for the Applicant concluded that in the light of above facts, and judgments cited supra, the denial of medical reimbursement to the Applicant is in total violation of Article 21 of the Indian Constitution. The Hon'ble Apex Court has observed that the Right to Health is an integral part of life. The government has a constitutional obligation to provide ajay mudgal CAT ajay Bangalore 2025.07.18 mudgal 17:22:20 +05'30' 28 O.A.No.170/00550/2022/CAT/BANGALORE health facilities to its employees or retired employees. If an employee requires specialised treatment in an approved hospital, it is the duty of the government to fully bear or reimburse the expenses in actuals.
34. Retired employees face serious health problems during their old age, and the government is obliged to help them with a sense of gratitude for service rendered in the past. The Applicant has responded to all of the Respondents' criteria and has been under the care of the empanelled doctors. Hence, the applicant is entitled to full reimbursement.
35. The learned counsel for the Respondents submitted his reply statement and stated that the Respondent's Directorate, being one of the Constituent Units of the Department of Atomic Energy, is responsible for survey, exploration and prospecting of precious and rare minerals like Uranium, Thorium, etc., used in the Nuclear Power Programme of the country and thus engaged in the sovereign function of the country. This Directorate has its headquarters at Hyderabad with seven Regional Headquarters at Shillong, New Delhi, Jamshedpur, Bengaluru, Nagpur, Jaipur and Hyderabad to effectively monitor the field establishments located all over India. Like any other Department of the Central Government, this Directorate also follows Fundamental Rules [hereinafter referred to as ajay mudgal CAT ajay Bangalore 2025.07.18 mudgal 17:22:20 +05'30' 29 O.A.No.170/00550/2022/CAT/BANGALORE "FRs" in short] and Supplementary Rules [hereinafter referred to as "SRs" In short], Central Civil Services Rules and regulations In general, in addition to the specific Rules and Orders made with the approval of the Department In so far as matters connected with Its personnel are concerned by virtue of empowerment of the Department under Allocation of Business Rules, 1961.
36. The Contributory Health Service Scheme (CHSS), presently existing In Department of Atomic Energy [DAE] and Department of Space [DOS] was introduced in DAE as a welfare measure, for the benefit of employees/pensioners during April 1975. This Scheme is different from CS (MA) Rules and Central Government Health Scheme (CGHS) existing in most other Central Government Departments. Under the scheme, various facilities like Authorized Medical Officers, Specialists, Hospitals, Clinical Laboratories, and Pharmacies etc. are recognized in the stations where the Scheme is available. Payment towards treatment availed by the beneficiaries are borne directly by the Scheme based on the approved rates or as per the Memorandum of Understanding (MoU) entered with different panel hospitals/diagnostic centres. Further, the facilities availed by the beneficiaries over and above the approved rates /Schedule of Rates are to be borne by ajay mudgal CAT ajay Bangalore 2025.07.18 mudgal 17:22:20 +05'30' 30 O.A.No.170/00550/2022/CAT/BANGALORE the respective beneficiaries/ individuals. The employees of the Department posted in Bengaluru are availing benefits of the scheme through a reciprocal arrangement made between Department of Atomic Energy and Department of Space. Similarly, pensioners at their option can opt for life membership by making one time contribution to the scheme at the time of their retirement.
37. The employees and their eligible family members of the Department of Atomic Energy (DAE) and all its Constituent Units located at different parts of the country are covered under the Contributory Health Services Scheme (CHSS) for medical purpose.
38. The learned counsel for the Respondents states that with the introduction of a similar medical Scheme under the Department of Space (DoS) for its employees, the DAE and DoS entered into a reciprocal arrangement for extending medical facilities under their respective schemes to the beneficiaries of either Department depending upon which Department is operating the Scheme in a particular location. Accordingly, under the reciprocal arrangement between the Departments, the employees and retired employees of the DAE & their eligible family members living in Bengaluru would be covered under the CHSS being operated by the DoS in Bengaluru. In ajay mudgal CAT ajay Bangalore 2025.07.18 mudgal 17:22:20 +05'30' 31 O.A.No.170/00550/2022/CAT/BANGALORE Bengaluru, the Departmental Unit dealing with CHSS matters is Atomic Minerals Directorate for Exploration and Research, Southern Region i.e. AMD (SR) for short.
39. It is also submitted by the learned counsel for the Respondents that on superannuation, the applicant shifted his residence from Mumbai to Bengaluru and opted to avail the CHSS facility being provided by DoS at Bengaluru under the reciprocal arrangement between the DAE and DoS.
40. The learned counsel for the Respondents admits that on relocation to Bengaluru, the applicant was assigned to Dr. R.S. Nagaraj (Authorised Medical Officer under CHSS, DOS) for regular health consultation and follow up. Considering his medical condition Dr. Nagaraj, referred the applicant to Dr. Shivaraj, Pulmonologist in Columbia Asia Hospital, Bengaluru for further diagnosis and treatment.
41. As the lungs of the applicant were irrevocably damaged. Dr. Shivaraj referred the applicant to Dr. Suresh Manickavel, Lung Transplant Specialist, Apollo Super Specialty Hospital, Chennai which is not an empaneled hospital for CHSS beneficiaries of Bangaluru. It is an empaneled hospital under CHSS of General Services Organisation (GSO), Kalpakkam, a Unit under DAE.
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O.A.No.170/00550/2022/CAT/BANGALORE
42. The learned counsel for the Respondents admits that Dr. Suresh, after evaluating the applicant, suggested immediate double lung transplantation surgery and advised him to undergo pre-lung transplantation evaluation tests as soon as possible. Based on the advice, the applicant vide letter dated 06.11.2017 requested Dept. of Space to enter into a package with Apollo Hospital, Chennai for enabling the applicant to proceed with the surgery.
43. According to the learned counsel for the Respondents, Lung transplantation being a very rare and unique procedure, there are no prescribed rates available under the CGHS, CHSS of the Department or under CHSS of DoS. Since the lung transplantation requested by the Applicant was not listed under the CHSS schedule of rates and also the estimated cost was more than Rs. 20 Lakhs, the case was referred by ISRO to their Departmental Medical Officers Committee for consideration and recommendations.
44. The Departmental Medical Officers Committee of ISRO recommended that the opinion of a Pulmonologist at M/s. Victoria Hospital/Bowring Hospital, Bengaluru should be secured and the same was communicated to the applicant. Accordingly, the applicant got himself examined and secured ajay mudgal CAT ajay Bangalore 2025.07.18 mudgal 17:22:20 +05'30' 33 O.A.No.170/00550/2022/CAT/BANGALORE the necessary opinion/certificate of Victoria Hospital, Bengaluru and submitted them to the Respondents.
45. The learned counsel for the Respondents submits that meanwhile, without waiting for the approval of the Department, the applicant underwent pre-lung transplantation evaluation tests and informed DoS about the same vide his letter dated 06.12.2017. The Applicant also executed an undertaking stating to bear any part of the inadmissible expenditure that will be sanctioned by the Government for the purpose at later date.
46. The applicant informed AMD SR vide letter dated 28.03.2018 about the successful double lung transplantation that he underwent on 25.02.2018. The applicant also submitted several medical claims in connection with the surgery and the details of the medical claims submitted by the Applicant and amount reimbursed initially is tabulated below:
S. Date of Purpose Amt. paid by Amt. sanctioned by the No. Bill the Applicant Respondent
1. 22/11/2017 Pre- Lung Rs. 2,82,309/- Nil Transplantation Expenditure
2. 04/01/2018 Same as above. Rs. 97,520/- Nil ajay mudgal CAT ajay Bangalore 2025.07.18 mudgal 17:22:20 +05'30' 34 O.A.No.170/00550/2022/CAT/BANGALORE
3. 05/03/2018 Lung Rs. 47,19,050/- Rs. 22,54,489/-
Transplantation Expenditure
4. 21/03/2018 Post - Lung Rs. 3,53,388/- Rs. 2,23,454/-
Transplantation Expenditure
5. 11/04/2018 Same as above Rs.6,29,691/- Rs.3,77,580/-
6. 02/06/2018 Same as above Rs.41,930/- Rs.21,479/-
7. 06/06/2018 Same as above Rs.2,08,832/- Rs.1,85,682
8. 10/07/2018 Same as above Rs.90,300/- Rs. 13,500/-
9. 14/07/2018 Same as above Rs. 4,44,000/- Nil TOTAL Rs.68,67,020/- Rs.30,76,184/-
47. According to the learned counsel for the Respondents, the claims were settled as per admissibility under CHSS and the admissible amount was arrived at after considering various factors viz., package rates, inadmissible medicines/consumables, etc.
48. The Applicant repeatedly requested for re-examination and reimbursement of the entire medical claim and even addressed a ajay mudgal CAT ajay Bangalore 2025.07.18 mudgal 17:22:20 +05'30' 35 O.A.No.170/00550/2022/CAT/BANGALORE letter to Grievance Officer, Dept. of Space requesting for reimbursement of entire medical expenditure. However, the same could not be accepted in the light of stated rules' position above.
49. Aggrieved by non-reimbursement of complete medical claims, the applicant filed the O.A. No. 170/00068/2020 pleading the Hon'ble Tribunal to direct the Department to reimburse the deficit claim of Rs. 37,90,836/- with 18% interest and also to pay compensation for inconvenience and mental agony suffered by the applicant. Hon'ble Tribunal, without entering to the merits of the case vide order dated 21.04.2022, directed the respondents to decide the applicant's claim within a period of 06 weeks from the date of receipt of Order.
50. According to the learned counsel for the Respondents, the Technical Standing Committee, after making extensive review and taking various parameters into consideration, opined that the claim is an Elective Surgery rather than Emergency Surgery and Applicant's case was a 'Donor Emergency' rather than a 'Recipient Emergency'. The Competent Authority in the Department vide order dated 29.07.2022, sanctioned an amount of Rs. 2,10,488/- (towards higher accommodation charges Post- Surgery and the pre-evaluation charges) against the total ajay mudgal CAT ajay Bangalore 2025.07.18 mudgal 17:22:20 +05'30' 36 O.A.No.170/00550/2022/CAT/BANGALORE balance amount of Rs. 37,90,836/- claimed by the applicant vide O.A. No. 170/68/2020.
51. The TSC found that out of 9 clauses of the Checklist under para 3 of the OM, only Clause 3(e) and Clause 3(i) were applicable in the case of the Applicant.
52. The TSC recommended reimbursement against Bills dated 05.03.2018 and 21.03.2018 respectively, besides reimbursement as actuals for the stay of the Applicant in the ICCU (Intensive Coronary Care Unit-ICCU). Under Clause 3(i), the TSC also recommended additional reimbursement of the pre-evaluation charges, restricted to admissible CHSS rates/MoU rates. Director, BARC and Joint Secretary (A&A).
53. The learned counsel for the respondents continues that DAE, jointly as representatives of Secretary, DAE even afforded an opportunity of virtual hearing to the Applicant on 25.07.2022 at 1500 hrs in the presence of the Controller, BARC; Head, Medical Division, BARC and Under Secretary (IR&W). The Department, taking into consideration the recommendations of the Technical Standing Committee constituted as per the directives of the Hon'ble Tribunal and also the facts presented by the Applicant during the virtual hearing on 25.07.2022, sanctioned additional reimbursement of Rs. 2,10,488/- under clause 3(e) and clause 3(1) of the OM dated 15.07.2014 ajay mudgal CAT ajay Bangalore 2025.07.18 mudgal 17:22:20 +05'30' 37 O.A.No.170/00550/2022/CAT/BANGALORE towards higher accommodation charges immediately post- surgery and the pre-evaluation charges, restricted to admissible CHSS rates.
54. According to the learned counsel for the respondents, the Applicant was properly diagnosed and appropriate medication was given to the Applicant and no wrong diagnosis or medication was given as claimed by the Applicant. Also, the Applicant was followed up regularly on anti TB treatment that was continued for 9 months duration. The Applicant was clinically better as evident by a weight gain of 5 kgs between 12/01/2004 and 09/08/2004. Further, the learned counsel for the respondents pointed out that the Applicant was referred to Dr. Mahashur after a period of seven months and not one year as falsely claimed by the Applicant. Hence, according to the learned counsel for the respondents, the contentions of the Applicant are not tenable.
55. According to the learned counsel for the Respondents, the Applicant underwent pre-lung transplantation evaluation tests and postfacto informed DoS about the same vide letter dated 06.12.2017. The learned counsel for the Respondents asserts that the Applicant vide said letter dated 06.12.2017 voluntarily executed an undertaking agreeing to bear the inadmissible ajay mudgal CAT ajay Bangalore 2025.07.18 mudgal 17:22:20 +05'30' 38 O.A.No.170/00550/2022/CAT/BANGALORE expenditure that will be sanctioned by the Government for the purpose at later date.
56. According to the learned counsel for the Respondents, the Applicant, consequent upon retirement (from DAE, HWB, Mumbai) on superannuation is availing the medical facilities (CHSS) administered by DOS at Bengaluru under the reciprocal arrangements with DAE, underwent lungs transplantation surgery at Chennai. Hence, for reimbursement of medical bills of the Applicant, several entities like DAE and its Units at Hyderabad, Bengaluru and Kalpakkam, along with DOS are involved in the entire procedure, which consumed considerable time in settlement of medical bills.
57. Rejecting the contention of learned counsel for the Applicant, the learned counsel for the Respondents placed reliance on the judgments of the Principal Bench CAT, in a medical reimbursement matter, which vide order dated 09.05.2018, in OA.No.3205/2018 held that:
"No State of any Country can have unlimited resources to spend on any of its project. That is why it only approves its projects to the extent feasible. The same holds good for providing medical facilities to its citizens including its employees. Provision of facilities cannot be unlimited. Hence, we come to the conclusion that the principle of fixation of rate and scale under this new policy is justified and cannot be held violative of Article 21 or Article 47 of the Constitution of India. "
ajay mudgal CAT ajay Bangalore 2025.07.18 mudgal 17:22:20 +05'30' 39 O.A.No.170/00550/2022/CAT/BANGALORE
58. The learned counsel for the Respondents admits that the M/s Apollo Hospitals, Chennai was empanelled under CHSS of General Services Organization (GSO for brevity), Kalpakkam a Unit under DAE and the bill of the Applicant has been referred to GSO, Kalpakkam for arriving the admissible amount as per directions of the Department. Accordingly, an amount of Rs. 22,54,489/- was reimbursed to the Applicant as against the claim of Rs. 47,19,050/- on 13.12.2018 based on the approval dated 07.12.2018 received from DAE. The counsel for the Respondents points out that, as per the estimate dated 13.11.2017 received from M/s. Apollo Hospitals, the approximate cost of the entire procedure was Rs. 40 Lakhs, as per the hospital rates. In their estimate, the hospital had mentioned Rs. 10.5 Lakhs as doctor's professional fees, whereas in the actual bill they have charged Rs. 26.75 Lakhs as professional fees. The admissible amount was reached after considering various factors viz., package rates, inadmissible medicines/consumables, etc.
59. The learned counsel for the Respondents avers that the decision taken by the Competent Authority in the Department is based on the recommendations of the competent Technical ajay mudgal CAT ajay Bangalore 2025.07.18 mudgal 17:22:20 +05'30' 40 O.A.No.170/00550/2022/CAT/BANGALORE Committee which had evaluated the matter on considering different parameters of the matter.
60. The learned counsel for the Respondents submits that the Applicant was given the best/appropriate treatment available throughout by regular referrals and follow up and also the claims towards his treatment availed Is settled as per the extant rules under CHSS.
61. Since, the Applicant had got himself tested / treated in private hospitals, the Departmental Medical Officers Committee of ISRO as per laid down rules recommended getting the opinion of a Pulmonologist at M/s. Victoria Hospital/Bowring Hospital, Bengaluru. Though, the applicant produced the necessary opinion/certificate of Victoria Hospital, Bengaluru, he, without waiting for the approval of the Department, underwent pre-lung transplantation evaluation tests and informed DoS about the same later, vide his letter dated 06.12.2017.
62. The counsel for the Respondents submits that no specific approval was conveyed by the Department for going ahead with the transplantation surgery. Hence, violation of Article 21 of the Constitution of India as alleged by the Applicant does not arise. In this regard, the learned counsel for the Respondents drew our attention to the judgment of the Hon'ble Supreme Court in the ajay mudgal CAT ajay Bangalore 2025.07.18 mudgal 17:22:20 +05'30' 41 O.A.No.170/00550/2022/CAT/BANGALORE case of State of Punjab & Ors. v. Ram Lubhaya Bagga (1998)4 SCC 117, which held that:
"Though the right under Article 21 obviously would include the right to lead a healthy life, yet such right cannot be considered as an absolute right and facilities are to be provided by the State within their financial constraints".
63. The learned counsel for the Respondents place reliance on the judgement of CAT Principal bench in O.A. No. 2207/2020 considering the ratio laid down by the Hon'ble Apex Court in the case of Shiva Kant Jha v. Union of India and State of Punjab & Ors. V. Ram Lubhaya Bagga, has held as follows:
"In view of the above, the Applicant's claim for reimbursement of the balance amount is not tenable. The Respondents have reimbursed the amount as due to the Applicant's father even for the treatments taken in non CGHS empanelled hospitals in terms of the rules and procedures of CGHS governing such claims. In view of the above mentioned, the claim of the Applicant for reimbursement of the full amount has no merit.
The OA is accordingly dismissed."
64. The learned counsel for the Respondents also invited our attention to the letter of the Applicant dated 06.12.2017. The ajay mudgal CAT ajay Bangalore 2025.07.18 mudgal 17:22:20 +05'30' 42 O.A.No.170/00550/2022/CAT/BANGALORE respondents submits the facts of the same for taking on record and consideration:
"Shri Y.S Prasad himself, vide his letter dated 06.12.2017 intimated that he 'may not be able to wait till receipt of the prior sanction', and that vide aforesaid letter Shri Y.S Prasad submitted an undertaking to undergo Lung Transplantation Surgery subject to reimbursement of expenditure under the CHSS of ISRO and "with a liability, if any, to bear any part of inadmissible expenditure by me"."
65. To summarise, the learned counsel for the respondent has made the following point:
1. The applicant was given the best possible treatment which could be avoided by the respondents
2. Despite lung transplantation being not on the schedule of diseases covered under CHSS, the respondents were very generous and have made substantial reimbursement to the applicant for the medical expenditure.
3. Respondents have totally complied with the directions of the Tribunal given in OA number 68/2020 and sanctioned additional amount of Rs. 2,10,488/- (Rupees Two Lakh Ten Thousand Four Hundred Eighty-Eight Only) to the applicant.
4. The applicant had gone ahead for the lung transplantation without securing formal approval of the respondents which was against the laid down procedures.
ajay mudgal CAT ajay Bangalore 2025.07.18 mudgal 17:22:20 +05'30' 43 O.A.No.170/00550/2022/CAT/BANGALORE
5. The applicant had herself given in writing that she will bear the expenditure over and above the legally permissible amount.
6. The respondents have reimbursed to the maximum extent possible the medical expenditure of the applicant and in view of limited resources, which have to be distributed amongst large number of CHSS beneficiaries, it is not possible to cater to the requirements of a single individual at the cost of many more similarly situated contenders.
66. The learned counsel for the Respondents also had cited several judgments of Hon'ble Supreme Court and High Courts, in support of his arguments. The relevant portions of the judgments cited by the counsel are indicated as below:
A. In the case of State of Punjab & Ors. vs Ram lubhaya Bagga & Ors., AIR 1998 SC 1703, states as thus:-
"Para 25. Now we revert to the last submission, whether the new State policy is justified in not reimbursing an employee, his full medical expenses incurred on such treatment, if incurred in any hospital in India not being a Government hospital in Punjab. Question is whether the new policy which is restricted by the financial constraints of the State to the rates in AIIMS would be in violation of Article 21 of the Constitution of India. so far as questioning the validity of governmental policy is concerned in our view it is not normally within the domain of any court, to weigh the pros and cons of the policy or to scrutinize it and test the degree of its beneficial or equitable disposition for the purpose of varying modifying or annulling it, based on however sound and good reasoning, except where it is arbitrary or violative of any constitutional, statutory or any other provision of law. When Government forms its policy, it is based on number of circumstances on facts, law including constraints based on its resources. It is also based on expert opinion. It would be dangerous if court is asked to test the utility, beneficial effect of the policy or its appraisal based on facts set out on affidavits. The Court would dissuade itself from ajay mudgal CAT ajay Bangalore 2025.07.18 mudgal 17:22:20 +05'30' 44 O.A.No.170/00550/2022/CAT/BANGALORE entering into this realm which belongs to the executive. It is within this matrix that it is to be seen whether the new policy violates Article 21 When it restricts reimbursement on account of its financial constraints.
Para 27. Coming back to test the claim of respondents, the State can neither urge nor say that it has no obligation to provide medical facility. If that were so it would be ex facie violative of Article
21. Under the new policy, medical facility continues to be given and now an employee is given free choice to get treatment in any private hospital in India but the amount of payment towards reimbursement is regulated. Without fixing any specific rate, the new policy refers to the obligation of paying at the rate fixed by the Director. The words are;
" .... to the level of expenditure as per the rate fixed by the Director, Health and Family Welfare, Punjab for a similar treatment package or actual expenditure whichever is less."
Para 28. The new policy does not leave this fixation to the sweet will of the Director but it is to be done by a Committee of technical experts.
Para 29. No State of any country can have unlimited resources to spend on any of its project. That is why it only approves its projects to the extent it is feasible. The same holds good for providing medical facilities to its citizen including its employees. Provision of facilities cannot be unlimited. It has to be to the extent finance permit. If no scale or rate is fixed then in case private clinics or hospitals increase their rate to exorbitant scales, the State would be bound to reimburse the same. Hence we come to the conclusion that principle of fixation of rate and scale under this new policy is justified and cannot be held to be violative of Article 21 or Article 47 of the Constitution of India." B. In the case of State of Karnataka & Anr. Vs. Vivekananda Swamy, State of Rajasthan & Ors. Vs Smt. Savitri upadyay, AIR 2008 SC 2080, states as thus:-
ajay mudgal CAT ajay Bangalore 2025.07.18 mudgal 17:22:20 +05'30' 45 O.A.No.170/00550/2022/CAT/BANGALORE "Para 18.In view of the aforementioned settled principles of law there cannot be any doubt that the Rules regarding reimbursement of medical claim of an employee when he obtains treatment from a hospital of his choice can be made limited. Such a rule furthermore having been framed under the proviso to Article 309 of the Constitution of India constitutes conditions of service in terms whereof on the one hand the employee would be granted the facility of medical aid free of cost from the recognized government hospitals and on the other he, at his option, may get himself treated from other recognized hospitals/institutions subject of course to the conditions that the reimbursement by the State therefor would be limited.
Para. 20. It, however, goes without saying that while exercising such a power, the authority must act judiciously keeping in mind the purport and object thereof. Considerations therefor, although may not partake a mathematical exactable but should always be fair and reasonable. Although it may not be possible for an employee to enforce a purported right on the premise that another person had obtained reimbursement for a similar kind of treatment, ordinarily fair procedure envisages a broad similarity. If any person has been shown any undue favour, we may add, by itself may not be a ground to favour another but when such a contention is raised, the State should be able to demonstrate a fair treatment. It is possible to draw a distinction on the basis of several factors, emergent situation being one of them. So viewed, we do not find that the State of Karnataka had acted arbitrarily." C. In the case of State of Rajasthan vs. Mahesh Kumar Sharma & Ors., (2011) 4 SCC 257, relevant paras from the aforesaid judgment are as follows:-
"Para 8. In this connection it will be profitable to refer to the judgment of a Bench of three Judges of this Court in State of Punjab and Others Vs. Ram Lubhaya Bagga and Others reported in (1998) 4 SCC 117 where the Bench has laid down that the Government would ajay mudgal CAT ajay Bangalore 2025.07.18 mudgal 17:22:20 +05'30' 46 O.A.No.170/00550/2022/CAT/BANGALORE be justified in limiting the medical facilities to the extent it is permitted by its financial resources. In the instant case, the Government has formulated necessary rules permitting the reimbursement of medical expenses in certain situations and upto a certain limit. The Government has been reimbursing the necessary expenditure as permitted by the rules uniformly. It will, therefore, not be proper for a Government employee or for his relatives to claim reimbursement of medical expenses otherwise than what was provided in the Rules."
D. In the case of Om Prakash Gargi vs. State of Punjab & Anr., (1996) 11 SCC 399, states as follows:-
"Para 4. We do not find any force in the contention. It is true that but for the benefit of reimbursement of the amount granted by the Government, the petitioner has no right to claim reimbursement. The question is: Whether on account of delay in reimbursing the amount incurred towards medical expenses, the State should be liable to pay also interest on the delayed payment? We are of the view that it is inexpedient and not proper to direct the State to pay interest for delay in payment of the reimbursement amount. lt requires verification of the amounts spent by the petitioner and similar person. His right only is to get reimbursement and it does not follow that for the delay in the payment of medical reimbursement, he should also be entitled to interest thereon. The order passed by this Court on an earlier occasion was to the effect of dismissing the special leave petition in limine. Therefore it does not furnish any for following the same. Under these circumstances, we do not think that it would be proper to direct payment of interest on the delayed reimbursement of the medical expenses incurred by a Government servant.
Para 5. The special leave petition is accordingly dismissed."
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67. We have given thoughtful consideration to the arguments and averments of the learned counsel for the applicant and the respondents. We have also gone through all the citations and judgements and other related documents furnished on record by the counsel for applicant and the respondents.
68. It is an admitted fact that the applicant retired as a Government employee from the Department of Atomic Energy. It is also not disputed that he was having Life Membership of CHSS. As a life member of CHSS, he was entitled to comprehensive medical treatment, as per permissible under the scheme. It is also well established that the applicant was under treatment for pulmonary related ailments under the hospitals of the respondents, since 2004. It is also understood that despite all possible treatment extended to the applicant by the respondents, there was progressive deterioration. It is also admitted that though the respondents have put in their best efforts, it was a serious case of wrong diagnosis of the applicant's disease as Tuberculosis, which was subsequently found to be 'Sarcoidosis'
69. It is also admitted that based on the recommendation of the designated Medical officer under CHSS, Dr RS Nagaraj, the applicant got himself examined by Dr. Shivaraj the Pulmonologist of Columbia Asia Hospital. Dr. Shivaraj, further ajay mudgal CAT ajay Bangalore 2025.07.18 mudgal 17:22:20 +05'30' 48 O.A.No.170/00550/2022/CAT/BANGALORE referred the applicant to Dr. Suresh Manickavel, the lung transplant specialist at Apollo Super Speciality Hospital, Chennai.
70. From the chronological sequence of events which have been put on record, it is clearly evident that the applicant underwent pre-lung transplantation surgery at Apollo Hospitals as his life was in danger. The medical documents clearly show that it had become a case of end stage, necessitating urgent surgical intervention.
71. On the other side, it cannot be denied that the respondents have also tried their level best to take medical care of the applicant, both during his Service and after Superannuation. He was given regular and best possible treatment at different hospitals of the respondents and also referred to Super Speciality Hospitals for treatment and care. His case was also referred to the Technical Committee for getting special approval for lung transplantation, which was not part of the CHSS schedule of diseases. He was also given the maximum possible medical reimbursement to the tune of rupees Rs.30,76,184/-. Subsequently, in compliance of the directions of this Tribunal, he was additional sanctioned Rs. 2,10,488/-.
72. From the above facts and circumstances and the judgements cited by the learned counsel for the applicant and respondents, ajay mudgal CAT ajay Bangalore 2025.07.18 mudgal 17:22:20 +05'30' 49 O.A.No.170/00550/2022/CAT/BANGALORE it is very clear that it is the sacred responsibility of the Government to provide best possible treatment & extend maximum medical reimbursement to a Government employee , whether serving or superannuated. It is well established that Right to Health is part of Right to Life and it is a Constitutional responsibility of the Government to ensure the same to all, particularly the government employees.
73. However, it cannot be denied that the Government has to function on the basis of the Utilitarianism principal (Bentham & Stuart Mill) which promote "The greatest amount of good for the greatest number of people.". The Government is meant for all its citizens and it cannot extend unlimited benefit to one individual, at the cost of benefits to many. It is seen that the total expenditure incurred by the applicant was Rs Rs.68,67,020/-. The applicant had been given total medical reimbursement to the tune of Rs.32,86,672/-.
74. Medical reimbursement of Rs. 32,86,672/- is substantial. Hence, it cannot be said that the applicant has not been adequately compensated for the expenditure incurred by him. The Government, with limited financial resources, has to cater to the needs of maximum number of beneficiaries which are covered under CHSS. This falls within the realm of policy making and the Courts are not expected to interfere in the ajay mudgal CAT ajay Bangalore 2025.07.18 mudgal 17:22:20 +05'30' 50 O.A.No.170/00550/2022/CAT/BANGALORE policies and regulations made by the Government, until and unless they are required to be evaluated on the touchstone of Constitutionality or they are perceived to be arbitrary and/or discriminatory. In this regard, the learned counsel for the Respondent has cited several judgements, Supra. The relevant extracts of some of these judgements cited by the learned counsel for the respondents are again reproduced below for easy of convenience:
A. In the case of State of Punjab & Ors. vs Ram lubhaya Bagga & Ors., AIR 1998 SC 1703, states as thus:-
"Para 25. .............
........ So far as questioning the validity of governmental policy is concerned in our view it is not normally within the domain of any court, to weigh the pros and cons of the policy or to scrutinize it and test the degree of its beneficial or equitable disposition for the purpose of varying modifying or annulling it, based on however sound and good reasoning, except where it is arbitrary or violative of any constitutional, statutory or any other provision of law.......
Para 27............
...........Under the new policy, medical facility continues to be given and now an employee is given free choice to get treatment in any private hospital in India but the amount of payment towards reimbursement is regulated.
Para 29. No State of any country can have unlimited resources to spend on any of its project. That is why it only approves its projects to the extent it is feasible. The same holds good for providing medical facilities to its citizen including its employees. Provision of facilities cannot be unlimited. It has to be to the extent finance permit.........
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O.A.No.170/00550/2022/CAT/BANGALORE ......Hence we come to the conclusion that principle of fixation of rate and scale under this new policy is justified and cannot be held to be violative of Article 21 or Article 47 of the Constitution of India."
C. In the case of State of Karnataka & Anr. Vs. Vivekananda Swamy, State of Rajasthan & Ors. Vs Smt. Savitri upadyay, AIR 2008 SC 2080, states as thus:-
"Para 18. In view of the aforementioned settled principles of law there cannot be any doubt that the Rules regarding reimbursement of medical claim of an employee when he obtains treatment from a hospital of his choice can be made limited. Such a rule furthermore having been framed under the proviso to Article 309 of the Constitution of India constitutes conditions of service in terms whereof on the one hand the employee would be granted the facility of medical aid free of cost from the recognized government hospitals and on the other he, at his option, may get himself treated from other recognized hospitals/institutions subject of course to the conditions that the reimbursement by the State therefor would be limited."
C. In the case of State of Rajasthan vs. Mahesh Kumar Sharma & Ors., (2011) 4 SCC 257, relevant paras from the aforesaid judgment are as follows:-
"Para 8.........
... It will, therefore, not be proper for a Government employee or for his relatives to claim reimbursement of medical expenses otherwise than what was provided in the Rules."
ajay mudgal CAT ajay Bangalore 2025.07.18 mudgal 17:22:20 +05'30' 52 O.A.No.170/00550/2022/CAT/BANGALORE D. In the case of Om Prakash Gargi vs. State of Punjab & Anr., (1996) 11 SCC 399, states as follows:-
"Para 4.........
.....His right only is to get reimbursement and it does not follow that for the delay in the payment of medical reimbursement, he should also be entitled to interest thereon........
.... Under these circumstances, we do not think that it would be proper to direct payment of interest on the delayed reimbursement of the medical expenses incurred by a Government servant.
75. Hence, in the light of the above facts and circumstances and the judgement cited Supra, and the clear statement of the applicant submitted to the respondents that he would bear the unreimbursed expenditure from his pocket, the relief sought by the applicant at 8.1 & 8.2 cannot be granted. This brings us to the third relief that the applicant has sought which is as follows:
8.3: Any other relief that the Tribunal maybe deem fit in the interest of justice, equity and good conscience.
This is examined at length as below:
It cannot be denied that for a retired Government employee, with a monthly pension of Rs. 33,000/-, incurring expenditure unreimbursed medical bills of Rs. 35,80,348/- is a huge burden on his financial resources. It is on record that the applicant had himself given in writing that he would bear the expenditure not sanctioned by the Respondents, from his pocket. However, it ajay mudgal CAT ajay Bangalore 2025.07.18 mudgal 17:22:20 +05'30' 53 O.A.No.170/00550/2022/CAT/BANGALORE was more of a Hobson's choice for him, as he was suffering from a life threatening disease and had very limited time left.
76. In this regard, it would be useful to have a look at the averments of the learned counsel for the Respondents which are produced ad verbatim as below:
a. Page No. 5 para 3 of the Reply states:
"The Contributory Health Service Scheme (CHSS), presently existing In Department of Atomic Energy [DAE] and Department of Space [DOS] was introduced in DAE as a welfare measure, for the benefit of employees/pensioners during April 1975. Under the scheme, various facilities like Authorized Medical Officers, Specialists, Hospitals, Clinical Laboratories, and Pharmacies etc. are recognized in the stations where the Scheme is available. Payment towards treatment availed by the beneficiaries are borne directly by the Scheme based on the approved rates or as per the Memorandum of Understanding (MoU) entered with different panel hospitals/diagnostic centres. Further, the facilities availed by the beneficiaries over and above the approved rates /Schedule of Rates are to be borne by the respective beneficiaries/ individuals. The employees of the Department posted in Bengaluru are availing benefits ajay mudgal CAT ajay Bangalore 2025.07.18 mudgal 17:22:20 +05'30' 54 O.A.No.170/00550/2022/CAT/BANGALORE of the scheme through a reciprocal arrangement made between Department of Atomic Energy and Department of Space. Similarly, pensioners at their option can opt for life membership by making one time contribution to the scheme at the time of their retirement."
b. Page No. 7, para 4.2:
"With the introduction of a similar medical Scheme under the Department of Space (DoS) for its employees, the DAE and DoS entered into a reciprocal arrangement for extending medical facilities under their respective schemes to the beneficiaries of either Department depending upon which Department is operating the Scheme in a particular location.
Accordingly, under the reciprocal arrangement between the Departments, the employees and retired employees of the DAE & their eligible family members living in Bengaluru would be covered under the CHSS being operated by the DoS in Bengaluru. In Bengaluru, the Departmental Unit dealing with CHSS matters is Atomic Minerals Directorate for Exploration and Research, Southern Region i.e. AMD (SR) for short."
c. Page No. 11, Para No. 4.9:
ajay mudgal CAT ajay Bangalore 2025.07.18 mudgal 17:22:20 +05'30' 55 O.A.No.170/00550/2022/CAT/BANGALORE "As the lungs of the applicant were irrevocably damaged.
Dr. Shivaraj referred the applicant to Dr. Suresh Manickavel, Lung Transplant Specialist, Apollo Super Specialty Hospital, Chennai which is not an empaneled hospital for CHSS beneficiaries of Bangaluru. It is an empaneled hospital under CHSS of General Services Organisation (GSO), Kalpakkam, a Unit under DAE."
77. From the above, it is very clear that the Department of Atomic Energy and the Department of Space had a reciprocal arrangement for treatment of their employees (both serving and Superannuated) covered under CHSS scheme at different facilities belonging to them and also hospitals with whom they had MoUs, subject to subscription of the Scheme.
78. It is also seen from the documents furnished by the respondents along their Memo dated 15.04.2024, vide Dy. No. 894/24, to us that a Memorandum of Understanding was signed, between the Department of Atomic Energy and Apollo Hospital, Chennai on 21st December 2017, for a period of 2 years (effective from 1st October 2017 as per para 15 of the MoU). For ease of understanding, the paras of the MoU, which would be of relevance in this way are reproduced as below:
ajay mudgal CAT ajay Bangalore 2025.07.18 mudgal 17:22:20 +05'30' 56 O.A.No.170/00550/2022/CAT/BANGALORE ".....Whereas the branches of Apollo Hospital viz. 1. Apollo Hospital, Greams Road, Nungambakkam, Chennai 600 006; 2. Apollo Speciality (Cancer) Hospital, Mount Road, Chennai 600 034 and 3. Apollo Speciality Hospital (OMR), Rajiv Gandhi Salai, Chennai 600 096, have been recognized as Panel Hospitals for providing (allopathic) medical treatment for specialties of Cardiology, Cardiac-Surgery, Neurology, Neuro- Surgery, Urology, Nephrology, Genetics, Oncology (Medical/Surgical), Radiology & Imaging and other super specialities/tertiary care management (as required for approved specialties only) under the Contributory Health Services Scheme (CHSS) of Department of Atomic Energy for treatment of the CHSS beneficiaries who will be referred with a valid referral letter....... ....................x...................x................x............
1. The Apollo Hospitals shall extend medical facilities to CHSS beneficiaries on receipt of a referral letter issued by DAE Hospital in the prescribed format and on verification of CHSS card issued to the patient.
2. Both outpatient and inpatient treatment and any other procedures under the approved package/tariff rates shall be extended on credit basis to the CHSS beneficiaries and no separate registration fees, file charges, certificate charges etc. will be charged. Cost tall required medicines, investigations, blood and blood components etc. shall be incorporated in the bills to be submitted by the referral Hospital. The charges therein shall be as per the approved tariff rates offered to DAE Hospital. The details of tariff ajay mudgal CAT ajay Bangalore 2025.07.18 mudgal 17:22:20 +05'30' 57 O.A.No.170/00550/2022/CAT/BANGALORE rates agreed/approved for DAE Hospital are indicated in the Annexures [I/II/III] applicable each branch of the Hospitals.
3. The package rate where applicable shall mean and include lump-sum cost of the procedures, comprising all admissible charges for which beneficiaries of CHSS of the Department of Atomic Energy are referred/permitted by the Competent Authority for the treatment from the time of admission to the time of discharge from the referred Hospital.
4. The charges for the treatment of all the categories of procedures/investigations are to be charged according to the approval rates chart.............
9. If a patient is admitted by an Attendant, where identity of the patient could not be established due to unconscious state etc. and later the patient turns out to be a CHSS beneficiary, in that case the agreed rates will be applicable.
................x.....................x..................x...............
15. The MoU will be valid for a minimum period of two years from the date of mutually agreed date i.e.01.10.2017. On its expiry, the MoU may be mutually reviewed for renewal by both parties. The MoU can be terminated by either party by serving three month (90 days) advance notice in writing. The rates indicated therein at the time of signing will remain fixed throughout the validity period of the MoU or till revision will be agreed upon mutually and as such will be binding on both the parties. DAE ajay mudgal CAT ajay Bangalore 2025.07.18 mudgal 17:22:20 +05'30' 58 O.A.No.170/00550/2022/CAT/BANGALORE Hospital will not be liable to pay any other charges not covered under the MoU. In case bills containing items not listed under the MoU are presented for payment, then DAE Hospital will reserve the right to admit or reject any such bills/claims in part or full."
79. From the above paras of the MoU, it is very clear that this MoU is applicable to all CHSS beneficiaries. Nowhere, in the MoU, it is mentioned that it is confined or limited to only CHSS beneficiaries/employees of the Department of Atomic Energy and Department of Space located in Chennai alone. Hence, the averments of the learned counsel for the respondents at para 4.9 at Page No. 11 of the reply are not tenable. It is an admitted fact that the applicant was a CHSS beneficiary. Since, the lung transplantation operation was performed upon the applicant on 25.02.2018, his case falls within the validity period of this MoU, which was initially for 2 years, i.e. from 01.10.2017 to 30.09.2019. As already stated by the Respondents' counsel in his reply, all the inclusive charges for performance of lung transplantation, as per the MoU with Apollo Hospital was of Rs. 25,00,000/-.
80. From the above, it is clear that the lung transplantation for the applicant was carried out during the period when the MoU between the APOLLO HOSPITAL, Chennai & Department of Atomic Energy Hospital, was valid and effective. It is also ajay mudgal CAT ajay Bangalore 2025.07.18 mudgal 17:22:20 +05'30' 59 O.A.No.170/00550/2022/CAT/BANGALORE repeatedly brought on record by the respondents that the employees of Department of Space and Department of Atomic Energy, both serving and retired (including the applicant who was a life time member of CHSS) were covered by reciprocal arrangements, regarding medical treatment and reimbursement.
81. In view of the above, it is clear that the Apollo Hospital in Chennai should not have charged one paisa more than Rs. 25 lakhs from the applicant for performance of this surgery, as clearly prescribed in MoU.
82. The above mentioned clauses of the MoU at Para 78 above should be read, juxtaposed with the following paras of the judgment of the Hon'ble Supreme Court in the case of Randeep Kumar Rana v. Union of India & Ors. decided by Hon'ble Delhi High Court in W.P (c) No. 2464/2003, which states as follows:
"Para 5. .............. There is another letter of the respondent at pages 22-23 of the paper-book in which it has been admitted that Escorts Heart Institute and Research Centre was also one of the hospitals which the petitioner was entitled for treatment. Now we come to the plea which has been taken by the respondent in the counter affidavit. It has been contended in para 11 of the counter affidavit that it is the duty of the citizens to see and ensure that such recognised hospital do not charge excess of the package rates. How a citizen can ensure ajay mudgal CAT ajay Bangalore 2025.07.18 mudgal 17:22:20 +05'30' 60 O.A.No.170/00550/2022/CAT/BANGALORE that a hospital does not charge over and above the package rate? The power to lay down guidelines is with the respondent. A citizen is a mere spectator to what State authority do and decide. If the hospital has charged over and above the package rate, the respondent is under an obligation to pay to such charges as the petitioner has incurred over package rates at the first instance and if in law state can recover from the hospital concerned, they may do so but they cannot deny their liability to pay to the Government employee who is entitled for medical reimbursement.
83.The case of the applicant clearly falls within the ambit of the above judgment and the MoU. Hence, the responsibility for ensuring that Apollo Hospital did not charge the applicant more than Rs. 25 Lakhs (as stipulated in the MoU cited supra), squarely and firmly lies on the respondents. The applicant, being a superannuated employee, was not aware of this MoU, and tethering on the boarder of death in desperation, paid an amount which was much more than what he should have been charged by the Apollo Hospital, as per the MoU. It is obvious that had the applicant been aware of this MoU, he would not have paid Rs. 68,67,020/- amount to the Apollo Hospital and undergone this torment and suffering of correspondence with the respondents and this very O.A itself. Hence, it would be in the fitness of the things that the Respondents reach out to the Apollo Hospital, Chennai and ajay mudgal CAT ajay Bangalore 2025.07.18 mudgal 17:22:20 +05'30' 61 O.A.No.170/00550/2022/CAT/BANGALORE emphatically insist upon and ensure complete recovery of the amount beyond Rs. 25 lakhs, which was paid by the applicant for undergoing the lung-transplantation surgery over there. It is felt that the ends of Justice will be met, if the respondents make sincere and conscious efforts to actively engage APOLLO HOSPITAL, Chennai to recover the excess amount which was charged from the applicant for the performance of lung transplantation beyond what was stipulated in the MoU. The excess amount, on recovery from APOLLO HOSPITAL should be remitted back to the applicant.
84. Hence, the relief asked for by the applicant in this O.A at para 8.3 is upheld. In view of the above, the following order are passed by this bench:
a. The relief asked by the applicant at para 8.1 and 8.2 are dismissed.
b. The relief asked by the applicant in para 8.3 - "Any other relief that the Tribunal may deem fit in the interest of justice, equity, and good conscience", is granted as follows:
i. The respondents will reach out to the management of Apollo Hospitals, Chennai and ensure compliance with the provisions of the MoU, with respect to the applicant by insisting upon them to return and refund the amount beyond Rs. 25,00,000/- which was the ajay mudgal CAT ajay Bangalore 2025.07.18 mudgal 17:22:20 +05'30' 62 O.A.No.170/00550/2022/CAT/BANGALORE prescribed amount for the lung transplantation surgery (as per the MoU) to the applicant. The amount recovered from APOLLO HOSPITAL, Chennai, for charges made to them by the Applicant, over and above ₹25 lakhs as per the MoU, should be distributed as follows:
a. The applicant should be paid the difference of the money between what he spent and the amount reimbursed to him under CHSS.
b. The remaining amount should be restored back to the respondent, who made the medical reimbursement to the applicant.
85. The Respondents are directed that compliance shall be carried out in an expeditious manner, in any event not later than 8 weeks from the date of receipt of Certified Copy of this order.
86. Hence, the OA is allowed to the extent mentioned above.
87. No order as to costs.
Sd/- Sd/-
(SANTOSH MEHRA) (JUSTICE B. K. SHRIVASTAVA)
MEMBER (A) MEMBER (J)
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