Central Administrative Tribunal - Delhi
Subhash Chand Gupta vs Gnctd on 7 January, 2026
1
Item No. 60 O.A. No. 1389/2022
Court No. IV
Central Administrative Tribunal
Principal Bench, New Delhi
O.A. No. 1389/2022
This the 07th day of January, 2026
Hon'ble Mr. Manish Garg, Member (J)
Hon'ble Dr. Anand S Khati, Member (A)
SUBHASH CHAND GUPTA
S/O LATE SHRI RAM RATTAN GUPTA
DEPUTY DIRECTOR (RETD.)
EMPLOYEE GROUP-A
R/O F-183,
PRASHANT VIHAR
DELHI-110085
...Applicant
(By Advocate: Mr. Anmol Pandita)
Versus
1. DIRECTOR OF EDUCATION
DIRECTORATE OF EDUCATION
GOVT. OF NCT OF DELHI
OLD SECETRIATE
DELHI-110054
2. DIRECTOR OF DGEHS
SHILPI GUPTA
SHILPI GUPTA
2026.01.12 GOVT. OF DELHI
16:26:15
+05'30' F-17, KARKARDOOMA
DELHI-110032
3. DIRECTOR OF MAIDS
MAIDS MAMC COMPLEX,
B.S. ZAFAR MARG
OLD DELHI-110002
...Respondents
(By Advocate: Mr. Amit Yadav with
Dr. Monika Bhargava)
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Item No. 60 O.A. No. 1389/2022
Court No. IV
ORDER (ORAL)
Hon'ble Mr. Manish Garg, Member (J) In the instant O.A. the applicant has prayed for the following reliefs:-
"a) a. Direct the Respondents to reimburse the applicant the complete cost of implant and interest @ 18% p.a. from date of such implant and all other consequential benefits.
b. Direct the respondents to pay the applicant an amount of Rs 2,00,000, as compensation and damages against the mental agony and pain suffered by the applicant.
c. Direct the respondents to Pay the litigation cost of Rs. 30,000/-to the applicant.
d. Set aside the order dated 25-08-2021 passed by Public Grievances Commission dismissing the complaint of the applicant.
e. Set aside the decision/order dated 17-02-2022 of the Deputy Director of Education rejecting the claim of the applicant for reimbursement.
f. Liberty be granted to the applicant to raise any other prayer as the applicant may necessary at any stage or during hearing.
g. Any other relief as the tribunal may be pleased to grant to the applicant which might not be covered within the contours of the above-stated prayer clauses."
2. Highlighting the facts of the present case, learned counsel for the applicant states that the applicant is SHILPI GUPTA 2026.01.12 SHILPI GUPTA 16:26:15 seeking payment of cost of tooth implantment. The +05'30' applicant had submitted his claim to the competent authority, but the same has not been granted to him.
2.1. The applicant got his medical tooth implant done form a DGEHS empanelled hospital Goel's Multi Specialty Dental Clinic and Implant Centre 7A/460, Durgapuri Exn., Loni Road, Delhi-110093.
3 Item No. 60 O.A. No. 1389/2022Court No. IV Dissatisfaction of the rejection of the non consideration of the case of the applicant, the applicant first of all approached Public Grievance Commission, Govt. of NCT of Delhi, who had passed the order dated 28.08.2021 in terms of para 2 (B) of the PGC Resolution No. F.4/14/94- AR dated 25.09.1997. At the outset, we may note that the said order dated 25.08.2021 has been challenged before this Tribunal by way of the present O.A. We make it clear that the said order passed by the Public Grievances Commission is not within the realm of this Tribunal to quash and set aside in exercise of powers.
However, the case of the applicant is being considered independently dehors the order so passed. The facts which have emerged during the hearing before the Public Grievance Commission is reproduced are reproduced herein below, for the sake or brevity:-
SHILPI GUPTA ""2.2 An action taken report dated 24.08.2021 has been 2026.01.12 SHILPI GUPTA 16:26:15 filed on behalf of Dy Director of Education (North-East II), +05'30' GNCT of Delhi. It is stated in the report that "Kindly refer to order No. PGC/2020/A.II/Edn./11 3151 dated 19.07.2021 regarding above case.. In compliance of specific order issued in para 34 to DDE(NE), it is humbly submitted that the relevant page from list of hospitals empanelled by Delhi Government is enclosed herewith. Name of Goel's Multispeciality Dental Clinic and Implant Centre 7A/450. Durga Puri Extension, Durga puri chowk, Loni Road, Delhi 93 from which the complainant Sh. S.C. Gupta had taken treatment, appears at S.No 11 in the list.
As far as redressal of grievance is concerned, it is subject to expert opinion from MAIDS to be communicated to Directorate of Health Services: GNCT of Delhi which further would communicate to this office in order to reimburse medical claim of Sh.S.C. Gupta. Same had been submitted 4 Item No. 60 O.A. No. 1389/2022 Court No. IV before Hon'ble Member during earlier hearings. In view of above submission, kindly dispose of the case."
2.3 Dr. Girish Prabhat from DGHS submitted that the case of the complainant has been sent to MAIDS for their expert opinion and the MAIDS nas stated that the procedure of tooth implantation is neither listed under the DGEHS scheme nor it is essential in nature. Further, the complainant did not explore other alternatives before opting for the said procedure Therefore, the case is not proper as per DGEHS rules and could not be approved.
2.4 The complainant present in the hearing submitted that as the DGHS and Education Department has been claiming that the procedure is not covered under the DGEHS rules, he has requested for copy of documents vide which the said Goel's Multispecialty Dental Clinic and Implant Centre claim reimbursement from the DGHS. However, the DGHS replied that the said documents has been burnt/destroyed and therefore, could not be provided to the complainant. He further submitted that he has filed RTI as to whether the procedure of tooth implantation is banned, to which, the DGHS submitted that the same is not banned. He further asked as to whether, second alternative procedure is available in his case to which, the DGHS has not given any answer.
2.5 The Commission noted that during the hearing dated 06.04 2021, the Addi. Director (DGEHS), Directorate of Health Services, GNCT of Delhi and the Dy, Director of Education, North East, GNCTD, vide their action taken report dated 05.04.2021 categorically submitted that on the basis of documents provided by Dy. Director of Education through email and clinical examination of the patient Sh.S.C. Gupta, Director (MAIDS) has given expert opinion in the matter as under
"Perusal of X-rays reveal that alternative essential procedures i.e. removable partial denture or bridge were SHILPI GUPTA also available for rehabilitation after tooth removal OPD SHILPI GUPTA 2026.01.12 papers and other prescription papers produced on 16:26:15 +05'30' 09.02.2021 do not reveal that the treating doctor had explored the alternative essential procedures. These documents were examined and it appears that implant was not the only essential treatment available for the patient and implant cannot be said to be essential in the instant case. As regards reimbursement of dental treatment, the same has to be examined by the Competent Authority as per rules and it is not under the purview of MAIDS In view of the expert opinion of MAIDS, the treatment taken by the patient was not essential therefore, reimbursement of tooth implantation is not admissible"
The Commission observes that the complainant's grievance regarding reimbursement for the procedure of tooth implantation done at empanelled hospital has been examined in detail by the concerned department i.e. 5 Item No. 60 O.A. No. 1389/2022 Court No. IV Directorate of Education and Directorate of Health Services (DHS), GNCT of Delhi and the DHS further sent the case of the complainant to MAIDS for their expert opinion. wherein, the Director (MAIDS) opined that OPD papers and other prescription papers do not reveal that the treating doctor had explored the alternative essential procedures Further, it appears that implant was not the only essential treatment available for the patient and implant cannot be said to be essential in the instant case, Therefore, after perusal of the record and stated positions taken by the Directorate of Health Services (DHS), GNCT of Delhi and MAIDS, it does not seem plausible for the respondent department i.e. Directorate of Education, GNCT of Delhi, to reimburse the complainant by going out of the ambit of DGEHS Rules.
However, keeping in view the fact that the complainant is a retired government servant who has been running from pillar to post for redressal of his grievance, the Director of Education, GNCT of Delhi is advised to reconsider the matter on sympathetic ground at their own level and apprise the complainant as well as the Commission of the outcome of this grievance."
Public Grievance Commission had directed the respondents to reconsider the case of the applicant on sympathetic ground.
3. Opposing the grant of relief, the learned counsel for the respondents relies upon the counter affidavit. He states that the case of the applicant was reconsidered / 2026.01.12 reexamined and rejected after taking an expert opinion. SHILPI GUPTA SHILPI GUPTA 16:26:15 +05'30' He refers and relies upon the same. He does not dispute the fact that there is no guidelines w.r.t. tooth implant / dental process/ treatment to be adopted thereto. He draws attention to a report submitted by an expert Dr. Sujata Mohanty, HOD, Oral Surgery, Maulana Azad Institute of Dental Sciences, New Delhi (Annexure-R1).
He states in terms of the same an alternate method was 6 Item No. 60 O.A. No. 1389/2022 Court No. IV not explored before tooth implant and therefore, the applicant is not entitled to relief.
4. Having heard the learned counsel for the parties and perused the records of the case.
5. After examining the case in hand, we observe that in RTI dated 24.09.2018, Govt. of NCT of Delhi,Directorate of Health Services, has stated as follows:-
"There are no ceiling rates for tooth implantation and approval for tooth implantation may be considered on case to case basis in consultation with experts."
In fact there are no guidelines to the said effect as well.
5.1. We draw a reference that in identical situation in the matter of Shiv Kant Jha Vs. Union of India, the Hon'ble Apex Court in Civil Original Jurisdiction, Writ Petition (Civil) No. 694/2015, had considered the case of an alternative treatment w.r.t. heart surgery in detailed and also the aspect of the medical reimbursement SHILPI GUPTA 2026.01.12 16:26:15 thereto. He draws a reference to para 12 to 16 of the said SHILPI GUPTA +05'30' decision, which reads as under:-
"12) With a view to provide the medical facility to the retired/serving CGHS beneficiaries, the government has empanelled a large number of hospitals on CGHS panel, however, the rates charged for such facility shall be only at the CGHS rates and, hence, the same are paid as per the procedure. Though the respondent-State has pleaded that the CGHS has to deal with large number of such retired beneficiaries and if the petitioner is compensated beyond the policy, it would have large scale ramification as none would follow the procedure to approach the empanelled hospitals and would rather choose private hospital as per their own free will. It 7 Item No. 60 O.A. No. 1389/2022 Court No. IV cannot be ignored that such private hospitals raise exorbitant bills subjecting the patient to various tests, procedures and treatment which may not be necessary at all times.
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.
14) This is hardly a satisfactory state of affairs. The relevant authorities are required to be more responsive SHILPI GUPTA and cannot in a mechanical manner deprive an 2026.01.12 SHILPI GUPTA 16:26:15 employee of his legitimate reimbursement. The Central +05'30' 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 8 Item No. 60 O.A. No. 1389/2022 Court No. IV 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.
15) In the present view of the matter, we are of the considered opinion that the CGHS is responsible for taking care of healthcare needs and well being of the central government employees and pensioners. 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 Rs. 4,99,555/- to the writ petitioner. We also make it clear that the said decision is confined to this case only.
16) Further, with regard to the slow and tardy pace of disposal of MRC by the CGHS in case of pensioner beneficiaries and the unnecessary harassment meted out to pensioners who are senior citizens, affecting them mentally, physically and financially, we are of the opinion that all such claims shall be attended by a Secretary level High Powered Committee in the concerned Ministry which shall meet every month for quick disposal of such cases. We, hereby, direct the concerned Ministry to device a Committee for grievance redressal of the retired pensioners consisting of Special Directorate General, Directorate General, 2 (two) Additional Directors and 1 (one) Specialist in the field which shall ensure timely and hassle free disposal of the claims within a period of 7 (seven) days. We further direct the concerned Ministry to take steps to form the Committee as expeditiously as possible. Further, the above exercise would be futile if the delay occasioned at the very initial stage, i.e., after submitting the relevant SHILPI GUPTA claim papers to the CMO-I/C, therefore, we are of the 2026.01.12 SHILPI GUPTA 16:26:15 opinion that there shall be a timeframe for finalization +05'30' and disbursement of the claim amounts of pensioners.
In this view, we are of the opinion that after submitting the relevant papers for claim by a pensioner, the same shall be reimbursed within a period of 1 (one) month."
6. Taking note of the aforesaid ratio laid down by the Apex Court in the matter of Ravi Kant Jha. It cannot be stated that the medical procedure adopted was a cosmetic one, there was a medical procedure known within the realm of the dental treatments. Merely 9 Item No. 60 O.A. No. 1389/2022 Court No. IV because there was an alternative remedy available as suggested by the Dr. Sujata Mohanty, HOD, Oral Surgery, Maulana Azad Institute of Dental Sciences, New Delhi is an opinion, cannot be strictly construed that even though it has not be revealed that treatment available for the patient and implant, which would deny the applicant of treatment meted-out for surgery of tooth implant there is no bar either.
7. In view of the same, the present O.A. is allowed. The respondents are directed to reimburse the amount of the expenses of the procedure as prayed for by the applicant within a period of two months from the date of receipt of a certified copy of this order.
8. Accordingly, the present Original Application is allowed. Associated M.As, if any, stand disposed of. No order as to costs.
SHILPI GUPTA 2026.01.12 SHILPI GUPTA 16:26:15 +05'30' (Dr. Anand S Khati) (Manish Garg) Member (A) Member (J) /SG/