Central Administrative Tribunal - Ernakulam
Kuttykrishnan Nair M K vs Indian Council Of Agricultural ... on 9 June, 2025
CENTRAL ADMINISTRATIVE TRIBUNAL
ERNAKULAM BENCH
O.A. No.180/00330/2024
Monday, this the 9th day of June, 2025
CORAM:
HON'BLE Mr. JUSTICE K. HARIPAL, JUDICIAL MEMBER
Kuttykrishnan Nair.M.K., Aged 79 years, S/o. M.A. Krishnan Nair
Technical Officer (Retd.), Central Institute of Fisheries Technology (CIFT)
Matsyapuri PO, Wellington Island, Kochi-682029 Residing at
Anugraha House, Aimuri, Perumbavoor, Ernakulam District, PIN:688544.
- Applicant
[By Advocates: Mr. K.P.Chandrasekhar, Mr.V.Anandashenoy]
Versus
1. The Secretary, Indian Council of Agricultural Research
Krishi Bhavan, New Delhi-110001.
2. The Director, Central Institute of Fisheries Technology
Matsyapuri PO, Wellington Island, Kochi-682029.
- Respondents
[By Advocate: Ms.K.V.Bhadra Kumari, SC]
The application having been heard on 19.05.2025, the Tribunal on
09.06.2025 delivered the following:
2025.06.09 13:40:16
DEEPA S
+05'30'
O.A.No.330/2024 2
ORDER
Applicant is a former Technical Officer, who retired from service of the Central Institute of Fisheries Technology, CIFT for short. When himself and his wife had fallen ill, expenses were met for the treatment, which were submitted to the 2nd respondent for reimbursement. Four such bills were submitted to the 2 nd respondent, but only partial reimbursement was made. Aggrieved by the same, he has approached this Tribunal for a direction to the respondents to grant him full reimbursement of medical expenses incurred under Annexures-A1 to A4 after deducting the amounts already sanctioned. He seeks further declaration that he is entitled to get full reimbursement of the medical expenses incurred by him.
2. It is explained that on 21.10.2023, after suffering giddiness and imbalance the applicant required an emergent treatment for which he was admitted in Ernakulam Medical Centre, which is not a recognized hospital and expended an amount of Rs.84,826/-. However, the 2 nd respondent reimbursed only Rs.63,598/-. Similarly, on 17.11.2023 he was admitted in Aster Medcity, Kochi for taking angiogram and was discharged 2025.06.09 13:40:16 DEEPA S +05'30' O.A.No.330/2024 3 on the same, for which Rs.18,718/- was expended. But the 2 nd respondent paid him only Rs.9,243/-. In the third instance, his wife Smt.P.K.Chandrika was admitted in Little Flower Hospital, Angamaly on 25.08.2023 and underwent surgery. She was discharged on 26.08.2023 and the total amount spent was Rs.27,859/-. However, the 2 nd respondent honoured only Rs.16,788/-. The fourth claim also pertains to the wife of the applicant in Dr.Tony Fernandez Eye Hospital, Aluva, where she underwent cataract surgery, for which inpatient treatment was required from 07.12.2023 to 08.12.2023. He spent Rs.21,811/-, but only Rs.16,150/- was reimbursed. Thus, the applicant submits that he had expended Rs.1,53,214/- for treatment in four hospitals, but the 2 nd respondent reimbursed only Rs.1,05,779/- leaving a balance of Rs.47,435/-.
3. According to the applicant, he is entitled to get medical expenses reimbursed under The Central Services (Medical Attendance) Rules, the Rules for short. He has highlighted Rules 3 and 6(1) of the Rules. He has also placed reliance on Annexure-A5 order of this Tribunal, which is a claim made by himself through O.A.474/2016. According to 2025.06.09 13:40:16 DEEPA S +05'30' O.A.No.330/2024 4 him, at that time also the 2nd respondent had made only partial reimbursement, which was challenged and this Tribunal allowed the O.A. and directed the respondents to pay him the entire amount. That has since been paid to him.
4. The 2nd respondent filed a reply opposing the claim. According to him, though provisions of the Rules are applicable to the applicant and his wife, only amounts as per the rates fixed by the Rules or CGHS Rules are payable to the applicant, which have been done. Here, the Ernakulam Medical Centre and Dr. Tony Fernandez Eye Hospital, Aluva are not recognized as approved medical centres. Still, all claims pertaining to approved hospitals have been admitted as per CGHS Thiruvananthapuram rates. He has also placed reliance on Annexures-R1 to R3 and submitted that further amounts are not payable.
5. The applicant filed a rejoinder reiterating the contentions in the O.A. According to him, ICAR has framed filed separate rules and regulations in respect of the medical benefits of the employees and pensioners. The Central Government employees will get reimbursement under the Rules in cities/towns. In addition, the Central Government also 2025.06.09 13:40:16 DEEPA S +05'30' O.A.No.330/2024 5 recognizes Public Hospitals/Public Trustee/Private Trusties Hospitals etc. for the treatment of its employees. The pensioners are covered by CGHS as in the case of serving employees. Employees of Institutes of the 2 nd respondent located outside Delhi are entitled for medical treatment as per the Rules. Pensioners of the council are covered by CGHS in Delhi only. Therefore, ICAR has taken decision to allow the employees outside Delhi to avail indoor medical facility in Public/Private/Private Trustee Hospitals. Thus orders have been issued by the 2 nd respondent on 20.04.2025 for availing medical facility for the employees of CIFT, which is stated in Annexure-A5.
6. Heard the learned counsel for the applicant as well as the learned Standing Counsel.
7. Relying on the decision of the Hon'ble Supreme Court in Shiva Kant Jha v. Union of India [AIR 2018 SC 1975] the learned counsel submitted that no fetters can be imposed on the rights of persons like the applicant. He has also produced a copy of the communication of the ICAR dated 22.01.1991 and submitted that such claims are regulated under the Rules, that the applicant is entitled to get full reimbursement. Basing on 2025.06.09 13:40:16 DEEPA S +05'30' O.A.No.330/2024 6 Shiv Kant Jha, quoted supra, according to the applicant, the act of the 2 nd respondent pruning the claim is illegal. The learned counsel also submitted that the wife of the applicant has since passed away.
8. On the other hand, according to the learned Standing Counsel, the respondents have not denied the right of the applicant to claim reimbursement. But the amount reimbursable depends upon set standards and rates fixed by the appropriate authorities under the Rules o CS(MA) or CGHS. Even though the Ernakulam Medical Centre and Dr. Tony Fernandez Eye Hospital, Aluva are not recognized centres, still amounts at approved rates have been reimbursed and no further amount can be granted.
9. As indicated earlier, the only question surviving for consideration is whether entire claim of the applicant as such is liable to be reimbursed without effecting any cut. The 2 nd respondent has not sanctioned the entire amount even though two hospitals were recognized. As rightly pointed out by the respondents, amounts, that are found payable in terms of the rates fixed by the Ministry of Health and Family Welfare alone can be reimbursed. Here, the split up figures 2025.06.09 13:40:16 DEEPA S +05'30' O.A.No.330/2024 7 claimed by the applicant in each bill is not available. The contention of the 2nd respondent indicates that the bills were meticulously examined and were accepted in tune with the rates fixed by the Government either under the Rules or under the CGHS. Clause 32.7.1 of the ICAR Establishment and Administration Manual reads thus:
"Departments have been delegated to Head of Office for setting permission cases and post facto approval to reimbursement in relaxation of rules in emergent cases under CGHS/CS(MA) Rules, 1944 which inter-alia provides that medical reimbursement in non-CGHS covered cities will be permissible as per the prescribed Rate-list of nearest CGHS-covered city or actual, whichever is lower, for CS(MA) beneficiaries."
10. Applicant is a resident at Perumbavoor. He has not subscribed to the CGHS. He is in receipt of fixed medical allowance of Rs.1,000/- per mensum. There is no separate rates for Ernakulam or other cities of Kerala State except Thiruvananthapuram. In Ernakulam there is only a wellness centre so that as per the standing instructions, the approved rates in Thiruvananthapuram Centre have to be taken into consideration.
11. It is also evident from the standing instructions (9-B page 123 2025.06.09 13:40:16 DEEPA S +05'30' O.A.No.330/2024 8 of the CS(MA) Rules 39th edition 2021) that, "Powers were delegated to the Head of Departments (HoDs) to decide the cases of medical claims in respect of treatment obtained in emergency at private hospital/private nursing home/private clinics, subject to item-wise ceiling prescribed under CGHS/CS(MA) Rules, 1944, irrespective of the financial limit on the total amount to be reimbursed."
12. Clause 10 of Annexure-R2(b) guidelines for recognition of private hospitals under CGHS for Central Government Employees and other family members reads thus:
"10. The rates charged by the hospital for various diagnostic and therapeutic procedures should be at par or less than the rates being charged by nearby private recognized hospitals of similar nature under CS (MA) Rules. If no such recognized hospitals are available in the nearby areas, rates may be compared with rates of C.G.H.S. approved hospitals in a similar class of city (as per classifications made by the Government in respect of City Compensatory Allowance)."
13. Annexure-R2(c) is an Office Memorandum in which Lakshmi Hospital, Ernakulam was empanelled as a recognized hospital for treatment of Central Government employees under the Rules. Here also, it is made clear that schedule of the charges for the treatment of the 2025.06.09 13:40:16 DEEPA S +05'30' O.A.No.330/2024 9 employees and members of the family under the Rules will be the rates fixed for CGHS under NABAH Thiruvananthapuram rates.
14. It is the specific case of the respondents that the rates fixed by the Government either under the CS(MA) Rules or CGHS were followed while processing the claims made by the applicant. The applicant has only stated generally that he had made a total claim for Rs.1,53,214/- in four bills, but only part of the same, that is Rs.1,05,779/- was honoured. The respondents have asserted that they have honoured the claims in accordance with the rates fixed under the Rules or the CGHS. In the circumstances, this Tribunal is unable to form an opinion as to how prejudice was caused to the applicant. The burden is on the applicant to establish that Rules were not followed in case or prejudice has been caused to him. In the absence of any motive for causing illegal loss to the applicant, on the basis of a general statement that full amount was not reimbursed, relief cannot be granted to the applicant. As mentioned earlier, such bills can be honoured only at the rates fixed by the Government under the CGHS or the CS(MA) Rules or the actual expenditure incurred, whichever is less. In the circumstances, this 2025.06.09 13:40:16 DEEPA S +05'30' O.A.No.330/2024 10 Tribunal has no other option but to believe the version of the respondents that they were following the rates for each procedure or treatment in accordance with the CGHS Thiruvananthapuram rates.
15. That means, the applicant is bound to fail.
16. It is true that the Hon'ble Apex Court held in Shiva Kant Jha, that no fetters can be imposed on the employees or pensioners in their claims. But reliefs were granted in that case taking it as a special case. The Hon'ble Supreme Court has made it clear that, that decision is confined to the case only. Annexure-A5 was rendered in a case of 2016 on 30.05.2017. That order was based on a previous decision of this Tribunal. So long as rates are fixed under the Rules/CGHS, the respondents are bound to follow the same. As already stated, the applicant could not make out that the 2 nd respondent had failed in following the said rates.
The Original Application is dismissed. No costs.
(Dated, this the 9th June, 2025) JUSTICE K.HARIPAL JUDICIAL MEMBER ds 2025.06.09 13:40:16 DEEPA S +05'30' O.A.No.330/2024 11 List of Annexures Annexure - A1: True copy of application for medical reimbursement of the applicant dated 06.11.2023 Annexure - A2: True copy of application for medical reimbursement of the applicant dated 27.11.2023 Annexure -A3: True copy of application for medical reimbursement of the applicant dated 12.09.2023 Annexure -A4: True copy of application for medical reimbursement of the applicant dated 26.12.2023 Annexure -A5: True copy of order dated 30.05.2017 in OA No474/2016 of this Hon'ble Tribunal.
Annexure-R2(a): True copy of the O.M. No:F.No: S.14025/14/2012-MS dated 11/6/2013 issued by Deputy Secretary to the Govt. of India.
Annexure R2(b): True copy of the relevant pages of guidelines for Recognition of Private Hospitals under Central Govt. Health Scheme (CGHS) and under CS (MA) Rules for Central Govt. Employees and their Family Members. Annexure R2(c): True copy of the O.M No:S.14021/08 2014-MS dt.11/6/2015 issued by Under Secretary to the Govt. of India.
************** 2025.06.09 13:40:16 DEEPA S +05'30'