State Consumer Disputes Redressal Commission
Additional Director Central Govt ... vs Ravinder Singh S/O. Sh Jaswant Singh on 31 December, 2025
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STATE CONSUMER DISPUTES REDRESSAL COMMISSION
U.T., CHANDIGARH
[ADDITIONAL BENCH]
Appeal No. : 199 of 2025
Date of Institution : 13.06.2025
Date of Decision : 31.12.2025
Additional Director, Central Government Health Scheme, Kendriya Sadan,
4th Floor, Sector 9-A, Chandigarh - 160009
....Appellant/Opposite Party
Versus
1] Ravinder Singh S/o S. Jaswant Singh R/o House No.50, Good Earth
Colony, Patiala - 147001, Punjab
2] Uttam Kaur W/o Sh. Ravinder Singh R/o House No.50, Good Earth
Colony, Patiala - 147001, Punjab
....Respondents/Complainants
BEFORE: MRS. PADMA PANDEY, PRESIDING MEMBER
SH. RAJESH K. ARYA, MEMBER ARGUED BY :-
Ms. Komal Preet Chauhan, Advocate (on video conferencing) alongwith Ms. Muskan, Advocate for the appellant Sh. Devinder Kumar, Advocate for the respondents alongwith Sh. Ravinder Singh, Respondent No.1 in person PER RAJESH K. ARYA, MEMBER The instant appeal has been filed by the opposite party - The Additional Director, Central Government Health Scheme (appellant herein) for setting aside order dated 28.02.2025 passed by District Consumer Disputes Redressal Commission-II, U.T., Chandigarh (hereinafter to be referred as 'District Commission') vide which, Consumer Complaint bearing No.290 of 2024 filed by the complainants - Sh. Ravinder Singh and his wife Smt. Uttam Kaur (respondents herein) has been partly allowed against the appellant by granting following relief:-2
"12] In view of the above discussion, the complaint of the complainants is partly allowed and the OP is directed as under: -
i) To reimburse the claim amounts of Rs.6640/- & Rs.22023/- (Annexure C-VIII) and Rs.36839/- & Rs.127118/- (Annexure C-IX) to complainants No.1 & 2 respectively alongwith interest @ 9% per annum from the date of denial of claim till the date of its actual realization.
ii) To pay Rs.25000/- to the complainants as compensation for the harassment caused as well as litigation expenses.
The above said order shall be complied with by the OP within a period of 60 days from the date of receipt of certified copy of this order.
13] With regard to the reimbursement of medical claim of Rs.22,799/- in respect of complainant No.1 for the period 22.07.2024 to 25.12.2024 and Rs.54,812/- in respect of complainant No.2 for the period 28.03.2024 to 25.12.2024, which have been subsequently claimed by complainants in their replication and written arguments, seem not to have been submitted to the OP for reimbursement. Hence, the same fall outside the purview of this Commission. Complainants are at liberty to submit Medical Reimbursement Claim for the said amounts Rs.22,799/- and Rs.54,812/- with the OP for of reimbursement. The original medical bills attached with the replication be returned to the complainants against receipt after retaining photocopies thereof."
2] In brief, the case of the complainants before the District Commission was that complainants No.1 and 2 are husband and wife. Complainant No.1 retired from the Central Reserve Police Force, while Complainant No.2 retired from Punjab Government service. At the time of retirement, Complainant No.1 subscribed to the Central Government Health Scheme (CGHS) by paying ₹60,000/- and opted to forego the fixed medical allowance of ₹1,000/- per month with pension. Complainant No.2 also opted to forego the fixed medical allowance of ₹1,000/- per month to avail OPD and IPD medical facilities under CGHS. Complainant No.1 suffered a stroke and remained under treatment at PGI in OPD and was also admitted in PGI from 11.12.2017 to 17.12.2017 in the Cardiology Department. Thereafter, he remained under treatment at Govt. Rajindra Hospital, Patiala and Fortis 3 Hospital, Mohali for emergent cardiac problems. He also suffered from Covid-19 on 06.04.2021. In view of his deteriorated health condition, doctors restricted his movements and advised continuation of medicines. Being resident of Patiala, he purchased medicines locally and underwent tests from time to time under emergent conditions. Complainant No.2, Uttam Kaur, also covered under CGHS for OPD and IPD medical coverage, suffered cardiac arrest and remained admitted in PGI, Chandigarh for treatment including cardiac angioplasty. She was also admitted in Govt. Rajindra Hospital, Patiala on 24.06.2022 and on being found to have 100% blockage, was shifted in emergency to Fortis Hospital, Mohali on 27.06.2022, where she remained admitted till 02.07.2022. Complainant No.2 suffered from multiple ailments including cardiac problems, arthritis and knee replacement (done in 2010) and was almost bed-ridden. Under these circumstances, medicines were purchased from local authorised chemist shops and requisite tests were conducted from local laboratories/diagnostic centres at Patiala. It was further stated that the bills of medical expenses incurred on consultations, tests, medicines and other charges were forwarded to the opposite party on 19.12.2022 and again on 15.11.2023 (Annexures C-VIII and C-IX) for reimbursement but the same were rejected vide letters dated 15.02.2023 and 17.11.2023 (Annexures C-X and C-XI) on flimsy ground that medicines were purchased from the market without affording any opportunity of hearing. Alleging said acts amounting to deficiency in service and unfair trade practice on the part of the opposite party, the complainants filed a consumer complaint before the District Commission seeking reimbursement of medical bills along with interest, compensation for mental harassment and litigation costs. 3] On the other hand, the opposite party in its reply filed before the District Commission stated that the Central Government Health Scheme (CGHS) provides comprehensive medical facilities to bona fide CGHS members holding a valid CGHS/Government card. It was further stated that as per CGHS guidelines, indoor treatment taken from hospitals is reimbursable while cashless facilities are available to pensioner beneficiaries for outdoor treatment in CGHS-empanelled hospitals and medicines are 4 issued from CGHS Wellness Centres. It was further stated that medicines prescribed by specialists, if not available at the Wellness Centre, are to be procured through authorised local chemists. Relying upon various Office Memoranda dated 24.07.1995, 28.03.2014, 23.12.2014 and 29.05.2019 as well as the Circular dated 16.02.2016, it was stated that OPD medicines purchased from the open market are not reimbursable and must be obtained from CGHS Wellness Centres or authorised chemists as per the CGHS formulary and guidelines. It was further stated that if beneficiaries purchase medicines from the open market, the very purpose of CGHS Wellness Centres, authorised chemists and government supply would be defeated and that several private laboratories are empanelled in Chandigarh, Panchkula and Mohali for diagnostic tests.
4] The complainants filed rejoinder before the District Commission wherein they reiterated all the averments made in the complaint and repudiated those as stated in the reply of the opposite parties. 5] The parties led evidence in support of their respective cases before the District Commission.
6] The District Commission after hearing arguments and considering the documentary evidence on record partly allowed the consumer complaint as stated above.
7] The order has been assailed by the appellant - opposite party on the ground that the District Commission lacked jurisdiction to entertain the complaint as the respondents are CGHS beneficiaries and their claims arise out of service conditions, which fall exclusively within the jurisdiction of the Central Administrative Tribunal under Section 28 of the Administrative Tribunals Act, 1985 and not consumer courts. It has further been stated that CGHS rules and Office Memoranda clearly bar reimbursement of OPD medicines purchased from the open market mandating that medicines be obtained from CGHS Wellness Centres or authorised chemists and reimbursement, if any, is restricted to CGHS rates without interest or compensation. It has further been stated that the respondents never properly approached the CGHS Wellness Centre, voluntarily purchased medicines and tests from non-empanelled local chemists and laboratories 5 including inadmissible items and failed to prove any non-availability of medicines. It has further been stated that the District Commission ignored binding guidelines, misapplied judicial precedents, awarded reimbursement contrary to CGHS norms and wrongly granted compensation and interest despite there being no deficiency in service as the appellant strictly followed the applicable rules and regulations. Lastly prayer for setting aside the impugned order and dismissal of the consumer complaint has been made by the appellant.
8] On the other hand, on behalf of the respondents-complainants, it has been contended that appeal filed by the appellant-opposite party challenging the impugned order is without any merit as CGHS envisages comprehensive medical facilities to its beneficiaries and the rejection of reimbursement on the ground that "OPD medicines purchased by CGHS beneficiaries are not reimbursable" is contrary to settled law. It has been stated that the Hon'ble High Court of Delhi in Smt. Kamlesh Sharma v. Municipal Corporation of Delhi, 2003 (3) SLJ 394 (Delhi) and the Hon'ble Supreme Court in Shiva Kant Jha v. Union of India, AIR 2018 SC 1975 have categorically held that denial of medical reimbursement on technical grounds is arbitrary, violative of Articles 14 and 21 of the Constitution and inconsistent with the object of a welfare state. It has further been stated that the complainants, senior citizens and lifelong CGHS members after foregoing medical allowance, suffered serious cardiac and other ailments, were advised to avoid travel and being residents of Patiala with the nearest CGHS Wellness Centre at Chandigarh, procured prescribed medicines and tests from authorised local chemists under compelling circumstances, especially when prescribed medicines were not available or were substituted by CGHS. It has further been stated that the complainants fall within the definition of "consumer" under the Consumer Protection Act, 2019, which is in addition to other remedies under the provisions of Section 100 of Consumer Protection Act 2019 and the jurisdiction of the Consumer Commission is not barred, particularly as Complainant No.1, a CRPF retiree, is not amenable to CAT jurisdiction. It has further been stated that the arbitrary rejection of reimbursement amounted to deficiency in service and 6 unfair trade practice and therefore, the judgment dated 28.02.2025 of the District Commission is legal, valid and calls for no interference. Lastly prayer for dismissal of the appeal with costs has been made by the respondents-complainants.
9] Before proceeding further, it may be stated here that there is a delay of 40 days as per the appellant & 42 days as per office report in filing the present appeal, for condonation whereof Miscellaneous Application No.541 of 2025 has been filed alongwith the appeal. The application has been contested by the respondents orally. The ground mentioned in the application for the delay is that the certified copy of the impugned order, sent through post, was received by the appellant on 24.03.2025; thereafter legal opinion from the concerned branch was sought on 27.03.2025 and in this process, delay happened in filing the appeal, which is bona fide and not intentional or deliberate. After going through the contents of the application, which is supported by an affidavit and in view of law settled by Hon'ble Supreme Court of India in Pundlik Jalam Patil Vs. Executive Engineer, Jalgaon Medium Project, (2008) 17 SCC 448 and Basawaraj and Anr. Vs. Special Land Acquisition Officer, (2013) 14 SCC 81, the appellant has shown rational reason for the delay, which has been caused due to bonafide reasons. Therefore, for the reasons given in the application which is supported by an affidavit and finding sufficient cause, the delay in filing the appeal is condoned. MA/541/2025 stands disposed of accordingly. 10] After hearing the Counsels for the parties and carefully examining the pleadings, documents on record, the impugned order, written arguments of the parties and the detailed findings returned by the District Commission, this Commission finds no merit in the appeal. The grounds raised by the appellant are misconceived, hyper-technical and fail to dislodge the well-reasoned order of the District Commission for the reasons recorded hereinbelow.
11] The principal plank of the appellant-opposite party's challenge is that the District Commission lacked jurisdiction as the dispute allegedly arises out of "service conditions" of CGHS beneficiaries and therefore falls exclusively within the jurisdiction of the Central Administrative Tribunal 7 under Section 28 of the Administrative Tribunals Act, 1985. This objection is wholly misconceived and untenable for multiple reasons. Firstly, the complainants are not agitating any issue relating to appointment, promotion, disciplinary action or service tenure. The grievance pertains to denial of medical reimbursement and medical facilities under CGHS after retirement, for which consideration has been paid. The complainants, at the time of retirement, consciously opted to subscribe to CGHS by paying ₹60,000/- as one-time subscription and by foregoing the fixed medical allowance of ₹1,000/- per month each. The availing of CGHS facilities is, therefore, not gratuitous but for consideration.
Secondly, Section 2(7) of the Consumer Protection Act, 2019 defines a "consumer" as a person who hires or avails any service for consideration. CGHS undeniably renders "service" within the meaning of Section 2(42) of the Act. The relationship between CGHS and its beneficiaries is, thus, squarely one of service provider and consumer. The respondents - complainants thus fall well within the definition of "consumer".
Thirdly, Section 100 of the Consumer Protection Act, 2019 expressly provides that the remedies under the Act are "in addition to and not in derogation of the provisions of any other law for the time being in force." The existence of a forum under the Administrative Tribunals Act does not oust or bar the jurisdiction of the Consumer Commission.
Fourthly, and more importantly, Complainant No.1 is a retired CRPF personnel, belonging to an armed force of the Union. Members of armed forces are not amenable to the jurisdiction of the Central Administrative Tribunal. Therefore, the plea that the respondents - complainants ought to have approached CAT is not only legally unsound but factually incorrect.
Moreover, the respondents-complainants have cited Shiva Kant Jha vs. Union of India (supra), wherein the Hon'ble Apex Court addressed the grievance of a retired CGHS beneficiary whose large medical reimbursement claims had been partly disallowed or restricted by the CGHS authorities despite genuine emergency treatment. The Hon'ble Apex Court held that the 8 Central Government Health Scheme (CGHS) is a welfare measure aimed at ensuring that government employees and pensioners are not left without medical care after retirement. It emphasized that a government employee or pensioner is entitled to the benefits of medical facilities under CGHS during life and after retirement and no fetters can be placed on such rights merely on technical grounds. It has further been held that the real test for reimbursement is whether the beneficiary actually underwent medical treatment supported by proper records certified by the treating doctors/hospitals. It has further been held that merely because treatment was taken in a hospital not strictly empanelled under CGHS or because prior approval was not obtained in emergencies, the claim cannot be denied. It has further been observed that the authorities must not reject claims in a mechanical or technical manner that frustrates the object of the CGHS. It has further been observed that in cases of emergency and genuine need, the beneficiary's choice of hospital, including non-empanelled hospitals and emergent interventions should not be used as a basis to deny reimbursement if the treatment was necessary for survival. The Hon'ble Apex Court expressed that CGHS authorities must be responsive and humane in dealing with senior citizens and pensioners, particularly when they face urgent medical needs and financial outlays for life-saving treatment. It further noted delays and hardships faced by pensioners in getting their medical claims processed and directed the establishment of mechanisms (including high powered committees at the Ministry level) to ensure speedy disposal of CGHS medical reimbursement claims. In essence, the Hon'ble Supreme Court held that genuine reimbursement claims under CGHS cannot be denied on mere technical grounds, particularly in emergency situations and that authorities must facilitate rather than frustrate the legitimate rights of retired beneficiaries to medical reimbursement under the scheme.
Further in 'The Deputy General Manager CPF. F.C.I, New Delhi Versus Kashmir Singh & Ors.', Revision Petition No.3317 of 2008 decided on 13.04.2015, the Hon'ble National Consumer Disputes Redressal Commission, New Delhi has held that an employee under the Employees' 9 Pension Scheme may be treated as a consumer under the Consumer Protection Act where he contributes to a pension/EPF scheme and thereby avails the services of administering authorities. The key is that contributions create a consideration making the relationship actionable as a consumer dispute.
Thus, the District Commission rightly assumed jurisdiction and the objection raised by the appellant is rejected.
12] The appellant has heavily relied upon various Office Memoranda dated 24.07.1995, 28.03.2014, 23.12.2014, 29.05.2019 and the Circular dated 16.02.2016 to contend that OPD medicines purchased from the open market are not reimbursable. At the outset, it is well-settled that executive instructions cannot override constitutional guarantees nor can they be applied mechanically to defeat the very object of a welfare scheme. CGHS is a welfare measure intended to provide comprehensive medical care to retired government servants so that they are not left medically or financially vulnerable in their post-retirement life. The District Commission has rightly noted that even assuming such instructions exist, the authorities were under an obligation either to issue the prescribed medicines or to process the reimbursement claim so that no loss was caused to the complainants. In the present case, neither was done. The bills were rejected and medicines were not issued thereby placing the respondents - complainants in a position of helplessness. The reliance on Office Memoranda to deny reimbursement, without considering the surrounding facts and compelling circumstances, amounted to arbitrary exercise of administrative power. 13] The factual matrix of the case clearly demonstrates that both complainants are senior citizens aged about 70 years, suffering from multiple serious ailments. Complainant No.1 suffered a stroke, underwent treatment at PGI, Chandigarh, remained admitted in the Cardiology Department and thereafter continued treatment for emergent cardiac issues at Govt. Rajindra Hospital, Patiala and Fortis Hospital, Mohali. He also suffered from Covid-19. His movements were medically restricted and he was advised continuity of medicines. Complainant No.2 suffered cardiac arrest, underwent cardiac angioplasty, had 100% blockage and was shifted 10 in emergency to Fortis Hospital, Mohali. She also suffered from arthritis and has undergone knee replacement, rendering her almost bed-ridden. 14] It is undisputed that the complainants are residents of Patiala, while the attached CGHS Wellness Centre is located at Sector 45, Chandigarh, approximately 75 kilometres away. There is no CGHS Wellness Centre at Patiala. In such circumstances, insisting that senior citizens suffering from serious cardiac ailments should repeatedly travel long distances to collect medicines would be inhumane, unreasonable and contrary to the right to life under Article 21 of the Constitution, as rightly observed by the District Commission in its order. The medicines were purchased strictly as per prescriptions issued by specialists from PGI, Fortis Hospital and Govt. Rajindra Hospital. There was no allegation of fabrication or misuse. The purchases were made from authorised local chemists and tests were conducted from local laboratories under emergent conditions. 15] The appellant has contended that medicines were available or that substitutes could have been provided. This argument lacks merit. The District Commission has correctly observed that CGHS authorities cannot sit in judgment over specialist prescriptions by forcing substitutions, especially in cases involving cardiac and life-threatening ailments. The right to proper medical treatment includes the right to receive medicines as prescribed by qualified specialists. Moreover, the appellant has failed to demonstrate that prescribed medicines were actually issued or made available to the complainants. Mere assertion of availability without evidence does not discharge the burden. The District Commission has rightly relied upon the authoritative judgment of the Hon'ble Supreme Court in Shiva Kant Jha vs. Union of India (supra) wherein the Hon'ble Apex Court has categorically held that the right to medical reimbursement cannot be denied merely because a hospital or treatment does not strictly conform to government orders; the real test is the factum of treatment duly supported by records; claims cannot be rejected on technical or mechanical grounds and CGHS is a welfare scheme meant to ensure medical care to retired employees in furtherance of the concept of a welfare state. Similarly, the Hon'ble Delhi High Court in Smt. Kamlesh Sharma vs. Municipal Corporation 11 of Delhi and another, (supra) held that denial of medical reimbursement on technicalities is arbitrary and violative of Articles 14 and 21 of the Constitution. The District Commission rightly applied these precedents to the present case. The appellant's contention that the District Commission misapplied judicial precedents is therefore unfounded. 16] The appellant has contended that there was no deficiency in service as the rules were strictly followed. This argument ignores the broader legal and constitutional framework. Deficiency in service includes arbitrary denial of legitimate claims, non-issuance of medicines, failure to consider medical exigencies and mechanical application of executive instructions without regard to human consequences. In the present case, the respondents - complainants were left to fend for themselves in their post-retirement life despite having paid consideration and surrendered medical allowance. Such conduct squarely amounted to deficiency in service and unfair trade practice, which the District Commission has rightly held so. The award of compensation and interest by the District Commission is neither excessive nor arbitrary. It is a natural consequence of prolonged harassment, denial of legitimate medical reimbursement and mental agony suffered by senior citizens battling serious illnesses. Compensation in consumer jurisprudence is intended not only to recompense loss but also to deter arbitrary conduct by service providers. The appellant has failed to show any perversity in the quantum awarded.
17] The District Commission has made significant and legally sound observations regarding the object of medical reimbursement to retired government servants. Pension and medical facilities are not acts of charity but deferred benefits earned through years of service. The right to health is an integral facet of the right to life under Article 21of the Constitution of India. Executive instructions cannot abridge this right, particularly when they operate harshly against senior citizens and pensioners. 18] Upon an overall consideration of the facts, evidence, applicable law and binding precedents, this Commission finds that the District Commission had proper jurisdiction, the respondents - complainants are consumers within the meaning of the Consumer Protection Act, 2019, the 12 rejection of medical reimbursement was arbitrary, mechanical and contrary to settled law, the appellant failed to discharge its obligations under the CGHS welfare scheme and the impugned order is well-reasoned, legally sound and free from perversity.
19] Accordingly, all grounds of appeal raised by the appellant- opposite party are rejected. The appeal is dismissed being devoid of any merit with no order as to costs. The impugned order dated 28.02.2025 passed by the District Commission-II, U.T., Chandigarh is affirmed in toto. 20] Pending application(s), if any, in this appeal also stands dismissed having been rendered infructuous.
21] Certified copies of this order be sent to the parties free of charge.
22] Copy of this order be also sent to the District Commission concerned.
23] File be consigned to Record Room after completion. Pronounced 31.12.2025.
(PADMA PANDEY) PRESIDING MEMBER (RAJESH K. ARYA) MEMBER *Ad* 13