Medical reimbursement cannot be denied on procedural grounds when treatment is genuine and necessary.

The applicant, Bhushan Prasad Sinha, an employee of the Department of Posts, sought reimbursement for medical expenses totaling Rs. 4,68,046/- incurred for his daughter, Richa Bharti's, scoliosis treatment and surgery at Ganga Hospital in Coimbatore on August 10, 2016.

Richa Bharti suffered from a severe form of scoliosis and was undergoing treatment at AIIMS, New Delhi, with the applicant informing the Department of her treatment.

The applicant took earned leave from May 30, 2016, to June 17, 2016, to avail LTC, during which time complications arose necessitating his daughter's treatment in Coimbatore.

The medical bill was formally rejected by a non-speaking order via PMG East Region Bihar Patna R.O. letter no. Acctte/P(E)/Med/R.Bharti/Nalanda Dn. dated May 26, 2017, communicated through a letter from the Superintendent of Post Offices, Nalanda Division, dated June 6, 2017.

The rejection was based on grounds that the applicant did not consult an Authorized Medical Attendant (AMA), the condition was not emergent, and the applicant failed to seek prior permission or admit his daughter to a government hospital.

The applicant filed an appeal with the Chief Postmaster General, Bihar Circle Patna, on July 19, 2017, which remained undecided.

1. Whether the impugned order rejecting the applicant’s medical reimbursement claim suffers from a violation of principles of natural justice due to being a non-speaking order.

2. Whether reimbursement of medical expenses can be denied solely on procedural grounds when the treatment is genuine and medically necessary.

3. Whether the claim of the applicant deserves reconsideration by the competent authority in accordance with the prescribed procedure.

The court primarily relied on the legal precedent set by the Hon'ble Supreme Court of India in Shiva Kant Jha vs. Union of India, Writ Petition (Civil) No. 694 of 2015 (decided on April 13, 2018), which established that the right to medical treatment is an integral facet of the right to life under Article 21 of the Constitution of India, and reimbursement cannot be denied merely because treatment was sought at a non-empanelled hospital if it was genuine and necessary.

It also referenced the Hon'ble Delhi High Court's decision in Yogesh Nirala & Ors. v. Union of India (dated October 30, 2015), which mandated a pragmatic and humanitarian approach to medical reimbursement claims.

The ruling in Shiva Kant Jha further laid down that a Secretary-level High Powered Committee should meet monthly for quick disposal of medical reimbursement claims, and established a one-month time limit for reimbursement after submission of relevant papers.

The court found that the rejection of the applicant's medical claim was based on procedural non-compliance, such as not consulting an AMA or obtaining prior permission, and was conveyed via a non-speaking order without detailed reasoning.

This violated the principle that administrative decisions affecting rights must be reasoned.

Applying the precedent from Shiva Kant Jha v. Union of India, the court noted that the right to medical treatment is a fundamental right under Article 21 and reimbursement cannot be denied for treatment at a non-empanelled hospital if the treatment was genuine and necessary.

The respondents did not dispute the genuineness or necessity of the daughter's spinal disorder treatment or the expenses incurred.

The court further observed that the decision to reject the claim was made by the Post Master General, who is not a medical expert, and without referring the matter to a medical professional committee, contrary to the established procedure for such claims.

Medical reimbursement schemes are welfare measures, and procedural requirements should not defeat the objective of providing essential medical assistance.

The court quashed and set aside the rejection order.

It directed the respondents to refer the applicant's case to a Committee of medical experts for proper examination and a final decision on the admissibility of the reimbursement amount.

This exercise was to be completed within three months from the date of receipt of the order.

The Original Application was, therefore, allowed to the extent indicated.