Fixed Medical Allowance does not preclude a pensioner’s right to reimbursement for specialized or extraordinary medical treatment.

The applicant, a 75-year-old retired Assistant Director of the Andaman and Nicobar Administration, retired from service on March 31, 2009

Between December 2020 and January 2021, while in Chennai, he underwent specialized cardiac treatment (angiography and other procedures) at Madras Medical Mission Hospital, incurring expenses of ₹4,24,573/-

In June 2024, he underwent eye surgery (Phaco Emulsification) in Kerala, costing ₹46,170/-

The respondent authorities, via a Speaking Order dated August 7, 2024, rejected his claim for medical reimbursement

The rejection was based on the grounds that the applicant received a Fixed Medical Allowance (FMA) with his pension, had not opted for the Central Government Health Scheme (CGHS), and had failed to utilize the cashless treatment facility under the Pradhan Mantri Jan Arogya Yojana (PMJAY)

The applicant challenged this rejection seeking full reimbursement with interest

1. Whether a pensioner receiving Fixed Medical Allowance (FMA) is precluded from claiming reimbursement for specialized or emergency medical treatment for serious ailments

2. Whether the non-option for CGHS or failure to use specific empanelled hospitals under PMJAY justifies the rejection of a medical reimbursement claim for life-threatening or specialized conditions

The court applied the principles governing medical reimbursement for Central Government pensioners as established in Union of India v. V.A. Abraham (WPCT No. 213 of 2004), which was upheld by the Supreme Court

It relied on the Ministry of Health and Family Welfare’s O.M. dated June 5, 1998, regarding the extension of CS(MA) Rules to pensioners in non-CGHS areas

The court further cited Shiv Kant Jha v. Union of India and Union of India v. Shri Amson (WPCT No. 9 of 2026), establishing that FMA is intended only for routine medical expenses and does not constitute a waiver of the right to reimbursement for extraordinary or specialized treatment

The Tribunal found that the respondents' reliance on the applicant's receipt of FMA and his non-enrollment in CGHS was legally untenable for specialized treatments

The court reasoned that FMA is a nominal sum meant for minor outpatient expenses and cannot be equated with a comprehensive medical cover for life-threatening diseases

Citing Union of India v. V.A. Abraham, the Tribunal noted that because adequate medical facilities for such serious ailments were unavailable in the Andaman and Nicobar Islands, the applicant was compelled to seek treatment on the mainland

The court emphasized that a "right to health" is a fundamental consideration, and technicalities regarding which scheme was opted for cannot be used to place "unreasonable restrictions" on a pensioner’s right to reimbursement for necessary surgeries

It held that the applicant is entitled to medical reimbursement regardless of his FMA status or non-option for CGHS

The respondents were directed to reimburse the medical expenses incurred for heart and eye treatments as per his submitted claims, provided they are verified as correct under the rules, within three months of receiving the order

The O.A. was disposed of with no order as to costs