Union Of India & Ors. vs Satyendra Kumar

$~56
* IN THE HIGH COURT OF DELHI AT NEW DELHI
# CNR No. DLHC010382382026
+ W.P.(C) 11885/2026, CM APPL. 55011/2026 & CM APPL.
55012/2026

UNION OF INDIA & ORS. .....Petitioners
Through: Mr. Deepender Banger and Ms.
Manisha Deo, Advs.

versus

SATYENDRA KUMAR .....Respondent
Through:

CORAM:
HON'BLE MR. JUSTICE C. HARI SHANKAR
HON'BLE MR. JUSTICE VINOD KUMAR
JUDGEMENT (ORAL)
% 31.08.2026

C. HARI SHANKAR, J.

1. We express our unmitigated distress at the fact that, despite
judgment after judgment having been rendered by Division Benches
of this Court, clearly holding that, in a case where medical treatment is
availed as a matter of urgency, the person availing medical treatment
is entitled to be reimbursed the actual medical expenses borne by her
or him, orders granting the said relief continue to be challenged before
this Court.

2. We may extract, for this purpose, the following passages from
the earlier decisions of Division Benches of this Court on the point:
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1
Union of India v. Joginder Singh

13. The medical claim for treatment undertaken in emergency
should not be denied for reimbursement merely because the
hospital is not empanelled. The test remains whether the claimant
had actually undertaken the treatment in emergent condition as
advised and if the same is supported by record. Preservation of
human life is of paramount importance. The State is under an
obligation to ensure timely medical treatment to a person in need of
such treatment and a negation of the same would be a violation of
Article 21 of the Constitution of India. Administrative action
should be just on test of fair play and reasonableness. Accordingly,
keeping into consideration the constitutional values, the executive
instructions need to be applied than rejecting the claim on technical
ground of undertaking treatment in a nonempanelled hospital, since
the CGHS/State is responsible to ensure proper medical treatment
in an emergent condition and further cannot escape the liability, if
the treatment undertaken is genuine. Any denial of claim by the
authorities in such cases only adds to the misery of the Government
servant by further forcing him to resort to Court of law.
14. Observations of the Hon'ble Apex Court in Shiva Kant
2
Jha (supra), as reflected in paras 17, 18 & 19 may also be
beneficially reproduced:—
“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 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

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2
Shiva Kant Jha v. UOI, ( 2018) 16 SCC 187
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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 Ministry concerned, 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.
19. 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.”

15. It needs to be kept in perspective that patient has a little
scope to decide the nature of treatment and merely looks forward to
an expert guidance/treatment for relieving him from immense pain
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and suffering. The patient in distress is not in a position to go
against the specialist medical advice for surgery in emergency.
16. Even assuming that in emergency, gamma knife surgery
may not render an immediate relief as contended by learned
counsel for the petitioners, but it is an established alternative
medical treatment for trigeminal neuralgia as per literature. There
may be a difference of opinion on the line of treatment to be
adopted by the experts but only the treating physician/surgeon
appears to be the best placed to adopt the right course of treatment
in an emergent situation.

3
Jasbir Singh v. Union of India

“24. The respondents are expected to be compassionate and give
a sympathetic consideration while considering the claim for
medical reimbursement, in order to mitigate the financial
hardships, rather than aggravate the situation by
rejecting/restricting the claims. It needs no reiteration that right to
health is integral to right to life and the authorities are under an
obligation to provide full reimbursement for medical facilities
availed in emergency.
25. Unfortunately, the respondents merely proceeded to deny
the ‘reimbursement claim’ without any clinching evidence to
conclude that emergency admission was not required at the nearest
hospital despite clear depiction in ‘emergency certificates’ given by
Paras Hospital for the subsequent admissions. The treating
doctors/physicians/specialists are best in position to assess whether
the emergent treatment is required in order to save the life of the
patient. In view of above, presumption drawn by the respondents
that the treatment was not in an emergent condition is unjustified in
the facts and circumstances of this case. The respondents, as such,
could not have denied the medical reimbursement claim for
subsequent admissions or restrict the claim in respect of first
admission in October, 2012.
26. For the foregoing reasons, the order passed by the Tribunal
restricting the claim in respect of first medical reimbursement and
order passed by the respondents denying the complete medical
reimbursement for subsequent admissions is set aside.
27. It is unfortunate that the petitioner has been made to run
from pillar to post for the purpose of reimbursement of medical
expenses on account of treatment of his deceased mother and has
been contesting the petition for over a decade. In the facts and
circumstances, respondents are directed to reimburse the medical

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claims preferred by the petitioner, after deducting the amount
already paid, along with simple interest @ 7% per annum.”

4
Jagir Kaur v. Union of India

6. The provision under Article 21 of the Constitution of
India ensures health and timely medical treatment being necessary
components of the fundamental right to life, and the same cannot
be negated or even diluted on the basis of bald suspicion of the
State that the non-empanelled hospitals would unjustly enrich
themselves even in such dire situations of the pandemic. Right to
health being an integral part of right to life, it was the bounden duty
of the State to ensure best possible medical treatment, at least for
survival of its Subjects through government medical facilities. And
that having collapsed, now the State cannot turn around to reject
the medical claims on the ground that the medical treatment was
availed from a non-empanelled hospital.
7. One cannot dispute the peculiar circumstances that were
created during Covid pandemic worldwide, in which on account of
extreme scarcity of medical beds and collapse of infrastructure,
number of lives were lost. During Covid, the unprecedented
calamity across the world, hospitals and clinics were inundated
with patients, far exceeding their capacity with extensive strain on
the intensive care units and emergency rooms. There was acute
shortage of medical oxygen, so the demand skyrocketed. The
pandemic exacerbated economic inequalities, whereby the
economically disadvantaged met with extreme difficulty to access
the necessary medical care. That crisis underscored the need for
comprehensive reforms in the healthcare sector across the world
and especially in our country writhing under severe resource
crunch. In such frantic and forlorn scenario the priority above
financial implications was to save lives of kith and kin, so one
could not be expected to wait for a bed and/or oxygen etc. in
CGHS panelled hospital. The Covid patients were being shifted
wherever the medical beds, oxygen, ICU and ventilators were
available across the country. Priority, as aforesaid was to save life.
8. The only test in such extraordinary situations must be as to
whether the medical treatment was actually availed of. Once the
answer is in affirmative, the reimbursement must be full while
dealing with such cases pertaining to Covid pandemic. In the
present case, it is not at all in dispute that late Sh. Pritam Singh had
to be admitted in the Indraprastha Apollo Hospital in emergency,
where he was diagnosed with Covid and in the course of medical
treatment, shuttling between the Ward and the ICU, he passed

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away while being on ventilator support. That should be a close of
the chapter so far as reimbursement claim of petitioner is
concerned.”

5
Hira Lal Bhat v. BSNL


“26. These decisions, which follow the exordium in Shiva Kant
Jha , make it clear that in a case in which the patient has to
undertake emergency treatment, she or he is entitled to
reimbursement of the actual expenses undergone. The Court cannot
go behind the Emergency Certificate. In such a situation, the issue
of whether the hospital is, or is not, empanelled, recedes into
insignificance. The only factor which remains as relevant is
whether the claimant did, or did not, undergo the concerned
treatment. If she, or he, did, complete reimbursement of the
expenses incurred must follow .

*

34. We express our displeasure at the manner in which this case
has been contested by the respondent. The Supreme Court, in the
passages from its judgment in Shiva Kant Jha already
extracted supra , has clearly advocated an expansive approach while
dealing with medical reimbursement claims of persons who have
undergone serious and emergency medical treatment. We regret to
say that these words of advice of Supreme Court have apparently
fallen on deaf ears as, in case after case where emergency treatment
is undertaken, the concerned persons, after having suffered the
ailment and undergone emergency treatment, are having to battle
for years before Court for getting their due reimbursement.”

3. The present case is squarely covered by the aforesaid decisions,
among others. The respondent’s wife Beena Kashmiri was a chronic
heart patient. She was admitted in Max Hospital from 9 to 16
February 2016. Thereafter, she was referred by the Railway Hospital
to the Delhi Heart & Lung Institute in an emergency and expired on 5
December 2018 during the course of treatment.


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4. The petitioner has, on affidavit, admitted, before the Tribunal,
that the respondent’s admission in the Railway Hospital was in an
emergency. The facts, even otherwise, make this apparent.

5. The respondent submitted his claim of ₹ 1,88,687/- being the
actual expenses undertaken by the respondent for the treatment of his
wife. Out of this, the petitioner paid only ₹ 75,399/-, even while
admitting that the respondent had to undertake the treatment in the
case of emergency.

6. The respondent, aggrieved by the aforesaid, petitioned the
6
Central Administrative Tribunal by way of OA 319/2025.
By judgment dated 24 March 2026, the OA has been allowed. The
petitioner has approached this Court, aggrieved by the said decision.

7. Learned Counsel for the petitioner places reliance on the
petitioner’s policy as well as the judgment of the Supreme Court in
7
Shiva Kant Jha v. UOI . We have dealt with the policy of the
petitioner as well as the judgment of the Supreme Court in Shiva Kant
Jha in the decisions cited by us supra from which the relevant extracts
already stand reproduced supra.

8. It is well settled, beyond any scope for doubt, that in a case
where emergency treatment is availed by a CGHS beneficiary, the
medical expenses have to be reimbursed.


6
“Tribunal” hereinafter
7
( 2018) 16 SCC 187
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9. Needless to say, if the treatment, or therapy, is elective rather
than emergent, this principle may not apply.

10. In that view of the matter, we find no error in the view adopted
by the Tribunal. The writ petition is accordingly dismissed in limine .

11. We direct compliance with the order of the Tribunal positively
within six weeks from today.


C. HARI SHANKAR, J.

VINOD KUMAR, J.
AR
AUGUST 31, 2026/
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