Genuine emergency medical treatment cannot be denied reimbursement solely on technical grounds or rigid package rates.

The applicant, an Assistant Accounts Officer under the Principal Accountant General (A&E), Odisha, contracted COVID-19 and was admitted to Kalinga Hospital Ltd., Bhubaneswar, an empanelled CGHS hospital, from 28 April 2021 to 9 May 2021.

He paid medical expenses of ₹1,30,334 and claimed reimbursement from the respondents.

The respondents reimbursed only ₹46,812, leaving a balance of ₹83,522.

The respondents justified the deduction by relying on the Central Government’s COVID-19 package rates under the Ministry of Health and Family Welfare Office Memorandum dated 10 July 2020 and the Government of Odisha’s letter dated 22 April 2021.

The applicant’s representations and request for reconsideration were rejected, including by communications dated 16 August 2021, 9 December 2021 and 17 February 2022.

He therefore filed the present Original Application seeking quashing of those communications and reimbursement of the balance amount.

Whether the respondents were justified in restricting the applicant’s COVID-19 medical reimbursement to ₹46,812 on the basis of prescribed package rates and refusing the balance claim of ₹83,522?

Whether the applicant’s claim was required to be reconsidered by an appropriate high-powered committee, applying the principles governing genuine and emergency medical treatment and the right to medical care?

The Tribunal applied the Government of India’s COVID-19 reimbursement guidelines contained in the Ministry of Health and Family Welfare, Directorate General of CGHS Office Memorandum dated 10 July 2020, read with the Government of Odisha Health and Family Welfare Department letter dated 22 April 2021.

It also relied on Shiva Kant Jha v. Union of India, (2018) 16 SCC 187, for the principle that medical reimbursement cannot be denied on technical grounds where the factum and genuineness of treatment are established, particularly in an emergency; the patient’s right to medical care must be interpreted consistently with Article 21 of the Constitution.

The Tribunal further relied on Kanak Lata Dash v. Union of India & Others, O.A. No. 12 of 2022, where it directed consideration of the claim by an appropriate committee in light of Shiva Kant Jha.

It also referred to Anirudh Prataprai Nansi v. State of Maharashtra, 2025 SCC OnLine Bom 2391, for the principle that exceptional and deserving medical cases should not be rejected through a narrow or mechanical application of fixed reimbursement rates, and that constitutional powers may be exercised to protect the right to life.

The Tribunal found that the applicant’s treatment for COVID-19 was genuine and that the respondents did not dispute either the treatment or the expenditure incurred.

Although the respondents relied on the prescribed COVID-19 package rates and contended that certain charges were inadmissible, the Tribunal held that the reimbursement claim required consideration beyond a purely technical application of the rates.

Applying Shiva Kant Jha, the Tribunal emphasised that the relevant inquiry is whether treatment was actually undertaken and supported by medical records, rather than whether every component of the expenditure falls within a rigid tariff.

The Tribunal considered the present case materially similar to Kanak Lata Dash, in which a medical reimbursement claim was directed to be examined by an appropriate committee in accordance with the constitutional and humanitarian principles governing medical care.

It therefore declined to uphold the respondents’ mechanical rejection and held that the applicant’s claim should be reconsidered by the competent committee with due regard to the genuine nature of the treatment, the emergency circumstances and the law laid down by the higher courts.

The committee was directed to reconsider and settle the applicant’s claim for full reimbursement, including the balance amount of ₹83,522, in accordance with law and the cited judicial principles.

The entire process, including reimbursement if recommended, was directed to be completed preferably within six weeks from receipt of the order.

The O.A. was accordingly disposed of, with no order as to costs; pending miscellaneous applications, if any, were also disposed of.