J. S. Bedi vs Union Of India And Anr.

$~30
* IN THE HIGH COURT OF DELHI AT NEW DELHI
+ W.P.(C) 7804/2023
Date of decision: 29.04.2026.
IN THE MATTER OF:-
J. S. BEDI .....Petitioner
( Through: Mr. Ankit Yadav, Mr. Aditya Sidhra, Mr. Areeb Husain,
Advocates.)
versus

UNION OF INDIA AND ANR. .....Respondents

(Through: Mr. Sushil kumar Pandey SPC, Mr Aman Kumar Pandey,
Mr Pradip Sharma Advocates for R-UOI.)

CORAM:
HON'BLE MR. JUSTICE PURUSHAINDRA KUMAR KAURAV
J U D G E M E N T

PURUSHAINDRA KUMAR KAURAV, J. (ORAL)


1. The instant petition is for the following reliefs:-
“ a) Pass a writ of mandamus or any other writ that this Hon’ble Court
may deem fit, directing the Respondents to reimburse an amount of
Rs.3,14,348/- [Rs. 2,65,342/- towards MRC-1 + Rs. 49,000/- towards
MRC-2, respectively] along with an interest at the rate of 12% from the
date of filing of the respective medical reimbursement claims;

b) Pass a writ of certiorari or any other writ which this Hon’ble court
may deem fit, setting aside the decision of High Powered Committee
dated 11.01.2019 and 11.02.2019 rejecting reimbursement claim of Rs.
2,65,342/- under Medical Re-imbursement claim filed on 27.01.2017 of
the Petitioner herein;

c) Pass a writ of mandamus or any other writ or direction which this
Hon’ble Court may deem fit, granting exemplary damages to the
Petitioner for the unjust hardship faced by the Petitioner.

Signature Not Verified
Signature Not Verified
Signed
By:PURUSHAINDRA
KUMAR KAURAV
Signed By:NEHA CHOPRA
Signing Date:08.05.2026
13:44:48

d) Pass such other order(s) or directions(s) as this Hon’ ble Court may
deem fit and proper in the facts and circumstances of this case.”


2. The petitioner, Mr. J.S. Bedi, a nonagenarian, is a retired IPS officer
of the 1957 batch. He served the nation for about 36 years and retired as
Secretary, Research and Analysis Wing ( „ R&AW‟) in 1993, having been one
of its founding members. He is a lifetime beneficiary of Central Government
Health Services („CGHS‟). He suffers from age-related ailments and
survived a heath attack in 2013, consequent to which three stents are placed
in his heart. His wife, the late Mrs. Mohini Bedi was also a CGHS
beneficiary who was diagnosed with advanced stage oral cancer in 2009 and
was treated thereof until her demise in 2018. Owing to the treatment, the
petitioner submitted the medical reimbursement claims dated 27.01.2017
and 06.11.2017 referred as MRC-1 and MRC-2, respectively, which were
partially reimbursed.
3. In the year 2016, the advanced malignancy of the Petitioner‟s wife
escalated to a medical emergency. The tumour had grown to block her air
passage through her nostrils and lips, placing her on the verge of
asphyxiation. In these life-threatening circumstances, three consulting
physicians, Dr. Narinder Pal, MD, FRCP (UK), FRCP (Ireland); Dr. Jamal
A. Khan, MBBS MD; and Dr. Rusy Bhalla, MS, prescribed a two-step
treatment protocol. First , Dendritic Cell Immunotherapy („DCT‟) at Denvax
Clinic, Vasant Vihar, New Delhi , followed by Laser Cutting of the oral
tumour at Parakh Hospital, Mumbai. Critically, neither of these treatments
was available at any CGHS empanelled hospital, leaving the Petitioner with
no option but to avail treatment at a private non-empanelled hospital.
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Signed
By:PURUSHAINDRA
KUMAR KAURAV
Signed By:NEHA CHOPRA
Signing Date:08.05.2026
13:44:48

4. Dr. Jamal A Khan also provided to the Petitioner a Sanction letter
dated 23.10.2015 issued by the Ex-Servicemen Contributory Health Scheme
(„ECHS‟) , Integrated HQ, Ministry of Defence (Army), sanctioning DCT
for another patient suffering from prostate cancer. This letter was shared by
the treating doctor to assure the Petitioner of the bonafides of the proposed
treatment and to indicate its potential reimbursability under a Central
Government health scheme. The Petitioner availed the treatment in good
faith, on the advice of qualified medical practitioners, supported by the
precedent of a sanction by another wing of the Central Government for the
very same therapy.
5. Later in October 2016, the Petitioner‟s wife was admitted in
emergency to Max Super Speciality Hospital , Saket, New Delhi (a CGHS
empanelled hospital), as the tumour had erupted further, causing severe
choking. On 19.10.2016 Dr. Satyapal Kataria, Consultant and Head,
Department of Medical Oncology, Safdarjung Hospital, prescribed
Nivolumab (another immunotherapy) for the patient. The very next day, the
patient was admitted to Max Hospital. The petitioner immediately filed a
request before the Technical Standing Committee (“TSC”) for sanction of
Nivolumab.
6. The TSC, on 21.10.2016, orally rejected the request on the ground
that Nivolumab was “ not approved treatment for Head and Neck cancer” ,
even though the very doctor who prescribed Nivolumab, i.e., Dr. Kataria,
was himself a member of the said TSC meeting. The petitioner then
personally approached the Secretary, Ministry of Health, whereupon the
TSC‟s decision was overruled and Nivolumab was sanctioned and
Signature Not Verified
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Signed
By:PURUSHAINDRA
KUMAR KAURAV
Signed By:NEHA CHOPRA
Signing Date:08.05.2026
13:44:48

administered. The Court notes with significance that Nivolumab has since
been recognised by CGHS as an approved treatment for Head and Neck
cancer. This episode illustrates, in sharp relief, the institutional tendency of
these Committees to characterise emerging treatments as “unapproved” and
to place procedural barriers before bonafide medical decisions of qualified
physicians.
7. To claim reimbursement, the Petitioner filed Medical Reimbursement
Claim No.1 (“MRC-1”) on 27.01.2017 for an amount of Rs.5,27,508/-
towards DCT and laser cutting treatment. Only Rs.2,62,160/- was
reimbursed by CGHS without assigning any reasons for the deductions and
without affording any opportunity of hearing to the petitioner. The balance
of Rs.2,65,342/- was left unreimbursed. Subsequently, Medical
Reimbursement Claim No.2 (“MRC-2”) was filed on 06.11.2017 for
Rs.5,04,362/- towards expenses at Max Hospital, of which Rs.3,04,398/-
was reimbursed, leaving a balance of Rs.49,000/-.
8. There does not remain any dispute with respect to the factum of
hospitalisation or the authenticity of the medical bills. All documents were
duly placed on record uncontested.
9. The Respondent High Power Committee („HPC‟) , constituted
pursuant to the directions of the Supreme Court in Shiva Kant Jha v. Union
1
of India , vide its recommendations dated 11.01.2019 and 11.02.2019,
rejected the reimbursement claim of Rs.2,65,342/- under MRC-1 on the
ground that the treatment was “not the recommended/approved treatment for

1
(2018) 16 SCC 187.
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By:PURUSHAINDRA
KUMAR KAURAV
Signed By:NEHA CHOPRA
Signing Date:08.05.2026
13:44:48

Head and Neck cancer.” No reasons were separately assigned for the denial
of Rs.49,000/- under MRC-2.
10. There does not remain any dispute with respect to the hospitalization
and medical bills etc. All those documents have duly been submitted to the
respondents. As of now, the reimbursement of a total amount of
Rs.3,14,348/- is pending, of which, an amount of Rs.2,65,342/- is towards
MRC-1 and Rs.49,000/- is towards MRC-2.
11. The Respondents in their counter affidavit pointed that five medical
claim reimbursements in total were submitted by the petitioner, out of which
the first three claims amounting to Rs.7,36,000/- were reimbursed in full.
The last medical claim which is the subject matter of the instant petition
amounting to Rs.2,65,342/- were dealt with in accordance with applicable
guidelines and admissible amount has already been reimbursed.
12. It is submitted that the CGHS has directly paid MAX Hospital an
approximately amount of Rs.29 Lakhs for the patient's inpatient admission
lasting close to six months. It is, however, submitted that the TSC and HPC
have duly considered the petitioner‟s case and have partly rejected the
reimbursement.
13. It is also submitted that DCT is a purely experimental therapy not
recommended by any national or international treatment guideline for head
and neck cancer; that the patient was specifically counselled regarding
recommended treatment options and had declined the recommended
treatment (Cetuximab) of her own volition; and that the CGHS cannot be
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Signed
By:PURUSHAINDRA
KUMAR KAURAV
Signed By:NEHA CHOPRA
Signing Date:08.05.2026
13:44:48

held liable for reimbursing unproven experimental therapies chosen
electively by patients
14. For the sake of clarity paragraph nos. 14 to 16 of the counter affidavit
are extracted as under:-
“14. In the petitioner's case it is clear from the clinical records of the
oncologist at Medanta that the patient had been counselled regarding the
treatment options available and that she did not wish to take cetuximab
which was the recommended treatment. Further he has stated that, in
response to an enquiry by the petitioner, he was informed about DCT and
also told that the same is not an approved therapy for head and neck
cancer. Similarly as stated by the petitioner, he took the opinion of the
medical oncologist at Safdarjung too, who also has at no point
recommended the patient to undergo this treatment. Copy of the
prescription of the oncologist at Medanta is annexed herewith at
ANNEXURE C4.

15 .Hence, it is evident that the petitioner by his own choice has
electively opted for the patient to undergo this experimental treatment.
The treatment evidently doesn't satisfy the criteria for full reimbursement
as laid down in the OM dated 6.6.18. It was certainly not a case of
emergent treatment and the treating medical oncologist has not
recommended it either. It is humbly submitted that clinical criteria are
·there to determine as to what constitutes a medical emergency. The
opinion of committees composed of medical oncologists dealing on a
daily basis ·with such cases has to be relied upon. They are well versed
in their fields and certainly qualified to judge whether the patient's
condition qualified as a medical emergency. That said, the intent here is
not to undermine the severity of the patient's disease or her suffering.
Advanced cancer can. be extremely debilitating, painful and harrowing
for both the patient and the family. Under CGHS norms cancer patients
are always granted special relaxation and priority as should be the case.
However, in this case 8 different medical oncologists from tertiary care
centres of Delhi including AIIMS as well as the Army Research and
referral hospital. have unanimously and unequivocally opined that· DCT
cannot be justified in this case. The same has been communicated to the
petitioner. Copies of the minutes of the various TSC and HPC meetings
considering the petitioner's cases are annexed herewith at Annexure C5.

16.That the granted, in the petitioner's case, considering the patient's
advanced malignancy and terminal illness:, they wished to try any form
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By:PURUSHAINDRA
KUMAR KAURAV
Signed By:NEHA CHOPRA
Signing Date:08.05.2026
13:44:48

of treatment available, but CGHS should not be held liable for
reimbursing unproven and unapproved experimental therapies that
patients may choose to undergo of their own volition. Not only would this
be an unjustifiable use of taxpayer money but would also set a very bad
precedent wherein we would be obliged to consider reimbursements for
all manner of such claims. Other pending balance payments in MRC 1
pertain to charges amounting to approximately Rs.38000 for palliative
laser ablation of tumour at Parakh Hospital, Mumbai which were over
and above CGHS rates and Rs. 27508 for expenses on air tickets for the
patient. and attendants from Delhi to Mumbai and back. The bill for
laser ablation has been settled as per guidelines with the unlisted
procedure reimbursed in full and other charges restricted to CGHS rates
as per norm. This treatment was planned and elective, hence does not
fulfil criteria for full reimbursement as per CGHS guidelines. Similarly
bills for the air tickets were regretted since air tickets are not
reimbursable under CGHS. The clause regarding requests for
reimbursement of air fare, which are to be considered by the HPC, is for
reimbursement of emergency air lift of patients by air ambulance,
requirement for which is to be certified by the treating doctor. MRC 2;
was submitted for expenses which were incurred by the petitioner while
the patient was admitted at an empanelled private hospital for 6 ·
months. This included charges on nursing, toiletries, physiotherapy and
diet supplements not routinely covered under CGHS.”


15. The Supreme Court in the case of Shiva Kant Jha has held that the
government employee during his/ her lifetime or after his/ her retirement is
entitled to get the benefit of the medical facilities and no fetters can be
placed on his rights. Paragraph nos.17 and 18 of the said decision are
extracted as under:-
“ 17) 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
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By:PURUSHAINDRA
KUMAR KAURAV
Signed By:NEHA CHOPRA
Signing Date:08.05.2026
13:44:48

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.

18) This is hardly a satisfactory state of affairs. The relevant authorities
are required to be more responsive and cannot in a mechanical manner
deprive an employee of his legitimate reimbursement. The Central
Government Health Scheme (CGHS) was propounded with a purpose of
providing health facility scheme to the central government employees so
that they are not left without medical care after retirement. It was in
furtherance of the object of a welfare State, which must provide for such
medical care that the scheme was brought in force. In the facts of the
present case, it cannot be denied that the writ petitioner was admitted in
the above said hospitals in emergency conditions. Moreover, the law
does not require that prior permission has to be taken in such situation
where the survival of the person is the prime consideration. The doctors
did his operation and had implanted CRT-D device and have done so as
one essential and timely. Though it is the claim of the respondent-State
that the rates were exorbitant whereas the rates charged for such facility
shall be only at the CGHS rates and that too after following a proper
procedure given in the Circulars issued on time to time by the concerned
Ministry, it also cannot be denied that the petitioner was taken to
hospital under emergency conditions for survival of his life which
requirement was above the sanctions and treatment in empanelled
hospitals.”

16. The foundational principle laid down by the Supreme Court in Shiva
Kant Jha (Supra) was affirmed and applied in Basant Dabas v. Govt of
2
India & Ors. holding that, admission of a CGHS beneficiary to a private
hospital is not, by itself, any ground to refuse reimbursement. In Union of

2
2019 SCC Online Del 9545.
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By:PURUSHAINDRA
KUMAR KAURAV
Signed By:NEHA CHOPRA
Signing Date:08.05.2026
13:44:48

3
India v. Shiv Ram Singh Naulakha this Court similarly directed full
reimbursement . On a similar line of reasoning, in Rajkumar v. Addl. Chief
4 5
Sec. to Govt. & Ors. ; Union of India v. Joginder Singh ; and GP Capt.
6
Suresh Khanna v. Union of India , the Court directed full reimbursement,
holding that genuine emergency medical treatment cannot be penalised on
the grounds of empanelment or rate-capping.
7
17. Additionally, in Jagir Kaur v. Union of India a Division Bench of
this Court, while setting aside the order of Central Administrative Tribunal,
directed full reimbursement of the outstanding medical expenses along with
the interest. Holding that in extraordinary situations such as COVID
pandemic, the only test must be whether medical treatment was actually
availed of, and once that is established in the affirmative, reimbursement
must be full. As denying it on the ground of capping circulars addressed to
hospitals would be unjust.
18. Learned counsel appearing on behalf of the petitioner places reliance
on the abovementioned line of authority and on Chief Sec. Govt. of NCT of
8
Delhi v. Anurag Manocha , which reveals a consistent approach flowing
from Shiva Kant Jha , holding that a CGHS or analogous scheme
beneficiary who receives genuine emergency medical treatment at a non-
empanelled or private facility is entitled to full reimbursement of the amount
actually incurred. Highlighting that the law on the question of medical

3
2019 SCC Online Del 11681.
4
2020 SCC Online Mad 4319.
5
2023 SCC Online Del 2707.
6
2023 SCC Online Del 3902.
7
2024 SCC Online Del 4698.
8
2023 SCC Online SC Del 7696.
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By:PURUSHAINDRA
KUMAR KAURAV
Signed By:NEHA CHOPRA
Signing Date:08.05.2026
13:44:48

reimbursement for treatment undertaken at non-empanelled or private
hospitals is no longer res integra.
19. In the instant case, Respondent‟s stand over DCT being
„experimental‟ and „not approved‟ ought to be rejected as per the Office
Memorandum dated 20.02.2009, issued by the Ministry of Health and
Family Welfare, which expressly provides that:-
“3(2)(b)… a checklist for consideration of requests for reimbursements
in excess of approved rates may include, the treatment obtained in a
private non-empanelled hospital under emergency for treatment of
advanced malignancy”
20. The petitioner‟s case falls squarely within the text of the Respondents‟
own circular. When the State formulates a beneficial circular extending
relief in cases of advanced malignancy, and then rejects a claim that falls
precisely within its terms, such action is self-contradictory and prima facie
arbitrary.
21. The entire reasoning of the Respondents proceeds on the factual
premise that the patient „electively‟ chose DCT by declining Cetuximab.
The patient was suffering from an advanced malignancy with the tumour
blocking her air passage, placing her in imminent risk of asphyxiation. In
such life-threatening circumstances, the decision as to the appropriate course
of treatment is pre-eminently a medical decision, to be made by qualified
physicians. The Supreme Court in Shiva Kant Jha held that:
“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
Signature Not Verified
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Signed
By:PURUSHAINDRA
KUMAR KAURAV
Signed By:NEHA CHOPRA
Signing Date:08.05.2026
13:44:48

22. A retrospective assessment by a committee after the treatment, that
the patient should have undergone a different treatment, cannot substitute for
a clinical judgment of the treating doctors who were present at the bedside
and responded to a medical emergency. To hold otherwise would be to
require patients and their families, in the throes of a life-threatening
emergency, to second-guess the prescriptions with an eye to future
administrative acceptability, which would amount to a standard that is
neither humane nor legally sound.
23. The Respondents contention that the decision of the Supreme Court in
Shiva Kant Jha is confined to the facts of that case on account of para 15 is
misconceived.
“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
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By:PURUSHAINDRA
KUMAR KAURAV
Signed By:NEHA CHOPRA
Signing Date:08.05.2026
13:44:48

operative relief to the parties before the Court, and cannot be read as a
judicial declaration curtailing the precedential value of the legal principles
enunciated therein. Phraseology does not, and cannot, efface the ratio that
emerges from the reasoning preceding such directions. To treat a restriction
on the relief as a restriction on the ratio is to conflate two jurisprudentially
distinct concepts and to render the substantive findings of the Court mere
surplusage.
25. For all the above-mentioned reasons, the Petitioner is entitled for
reimbursement of the outstanding balance amount of Rs.3,14,348/-
(comprising Rs.2,65,342/- towards MRC-1 and Rs.49,000/- towards MRC-
2). The payment of the underlying medical expenses has already been made
by the petitioner out of his own pocket, and all supporting bills and records
have already been placed before the Respondents
26. Let the matter be considered by the appropriate Committee within a
period of three months from the date of receipt of copy of the order passed
today.
27. With the aforesaid observations, the instant petition stands disposed
of.
(PURUSHAINDRA KUMAR KAURAV)
JUDGE
APRIL 29, 2026/ Nc/NK
Signature Not Verified
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Signed
By:PURUSHAINDRA
KUMAR KAURAV
Signed By:NEHA CHOPRA
Signing Date:08.05.2026
13:44:48