Facts
The applicant, an Inspector of Income Tax (now represented by his widow and daughter), suffered from a chronic heart condition.
Source reference: p. 4, para. 2.1After several hospitalizations and medical opinions from government and private institutions, he was advised to undergo a heart transplant surgery—a facility unavailable in local government hospitals at the time.
Source reference: p. 5, para. 2.3He underwent the procedure at Fortis Malar Hospital, Chennai, incurring expenses totaling approximately ₹16 lakhs.
Source reference: p. 6-7, paras. 2.5-2.7The respondents restricted his reimbursement to Central Government Health Scheme (CGHS) package rates despite departmental recommendations for full reimbursement under relaxation of rules.
Source reference: p. 8, para. 2.10-2.11The applicant challenged the communications dated 27.03.2017 and 06.07.2017 which denied full reimbursement.
Source reference: p. 3, para. 1Issues
1. Whether the respondents were justified in restricting the medical reimbursement to CGHS package rates when the procedure was life-saving and undertaken in emergent circumstances.
Source reference: p. 16, para. 72. Whether the respondents failed to follow the prescribed procedure for relaxation of rules and the guidelines issued by the Ministry of Health and Family Welfare.
Source reference: p. 20, para. 12; p. 22, para. 15.1Law Applied
Article 21 of the Constitution of India, which encompasses the right to health as an integral part of the right to life.
Source reference: p. 17, para. 10Medical reimbursement cannot be denied on technical grounds or restricted to package rates if the treatment is bona fide and necessary for survival, as per Shiva Kant Jha v. Union of India (2018) 16 SCC 187.
Source reference: p. 17, para. 10.1Ministry of Health and Family Welfare OM dated 06.06.2018, which mandates the formation of a High-Powered Committee (HPC) for the settlement of full reimbursement claims in exceptional cases.
Source reference: p. 21, para. 13The necessity of granting relief when a legal right is justified, referencing Mahendra Prasad Agarwal v. Arvind Kumar Singh & Ors. (2026).
Source reference: p. 21, para. 14Reasoning
The Tribunal reasoned that the applicant’s heart transplant was a life-saving procedure necessitated by the non-availability of facilities in government hospitals.
Source reference: p. 20, para. 11While the department initially recommended relaxation, the subsequent rejection was a "mechanical application of rules" that ignored the "real test" of the factum and genuineness of treatment established in Shiva Kant Jha.
Source reference: p. 18, para. 10.1The Tribunal found that the respondents committed a procedural error by not placing the applicant's case before the High-Powered Expert Committee as required by the OM dated 06.06.2018.
Source reference: p. 22, para. 15.1The decision-making process was deemed arbitrary and reflective of "non-application of mind," as the authorities failed to adopt the "humane and pragmatic approach" required in medical exigencies.
Source reference: p. 17, para. 10; p. 22, para. 15Holding
The Tribunal partially allowed the O.A. and quashed the impugned communications dated 27.03.2017, 06.07.2017, 04.04.2018, and 31.10.2018.
The respondents were directed to place the applicant’s case before the High-Powered Expert Committee within 30 days to decide on the full reimbursement of medical expenses and pass a reasoned speaking order within eight weeks. No order as to costs was made.
Source reference: p. 24, para. 17(ii); p. 24, para. 17(iii); p. 24, para. 18Original Court PDF
HANSHHABEN K GHEDIAvsCentral Board Of Direct Taxes
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