Fixed Medical Allowance does not preclude pensioner reimbursement for specialized treatment of life-threatening diseases.

The applicant, an 82-year-old retired Junior Accounts Officer, retired in 2003 and initially opted for Fixed Medical Allowance (FMA)

Pursuant to a 2024 government circular, he opted for the Central Government Health Scheme (CGHS) facility, and his FMA was discontinued effective March 2024

In February 2025, the applicant was diagnosed with cancer at G.B. Pant Hospital, Port Blair, and subsequently traveled to Apollo Cancer Hospital, Chennai, for specialized surgery and radiotherapy, as such facilities were unavailable in the Andaman and Nicobar Islands

He incurred expenses totaling Rs. 7,11,988 and submitted a reimbursement claim on August 4, 2025

The Respondent No. 6 rejected the claim via communication dated October 29, 2025, asserting that no specific circular existed for extending reimbursement to pensioners and that cases must be decided on individual merit

The applicant challenged this rejection before the Tribunal.

1. Whether a retired government employee (pensioner) is entitled to medical reimbursement for specialized treatment despite the absence of a specific administrative circular

2. Whether the rejection of a medical claim on the grounds of non-issuance of a circular is legally sustainable when the applicant is a CGHS beneficiary and the required treatment was unavailable locally

The Tribunal applied the Ministry of Health and Family Welfare O.M. dated June 5, 1998, which extends CS(MA) Rules to pensioners in non-CGHS areas to ensure they are not deprived of medical facilities in old age

It further relied on the DoP&T Circular dated May 1, 2023, confirming the nationwide validity of CGHS cards for treatment

Crucially, the Tribunal followed the judicial precedents set in Union of India v. V.A. Abraham (WPCT 213/2007) and Shiv Kant Jha v. Union of India (2018), which established that the right to health is a fundamental right and that technicalities like the lack of a circular cannot override the government's obligation to reimburse life-saving medical expenses

The Tribunal also cited Union of India v. Smti Malti Tiwari (WPCT 11/2026), affirming that FMA is intended only for routine expenses and does not constitute a waiver of the right to reimbursement for extraordinary treatment

The Tribunal reasoned that the respondents' denial based on the "non-availability of a circular" was invalid, as judicial decisions by the High Courts and Supreme Court constitute the "law of the land"

It noted that the applicant had officially transitioned from FMA to CGHS in March 2024, making him a bona fide CGHS beneficiary entitled to treatment anywhere in India under the May 2023 guidelines

The Tribunal observed that since specialized cancer treatment was unavailable at G.B. Pant Hospital in Port Blair, the applicant had no choice but to seek treatment on the mainland

It further emphasized that even if the applicant were not a CGHS beneficiary, the settled legal position across multiple precedents (e.g., Amson, Malti Tiwari, and Abraham) mandates full reimbursement for pensioners undergoing specialized treatment for life-threatening diseases

It held that the applicant is entitled to the reimbursement of his medical expenses as a CGHS beneficiary and per established judicial precedents

The respondents were directed to reimburse the sum of Rs. 7,11,988 to the applicant within three months from the date of receipt of the order

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