Medical reimbursement cannot be denied on technical grounds of delayed intimation in emergency life-threatening situations.

The applicant, Girija Devi, is the widow of Shri Vijay Bahadur Singh, who retired as an SDE from BSNL in 2004.

On 26.10.2020, the husband fell seriously ill and was admitted to Vardhan Hospital under emergency conditions (hypertension and pneumonia), then shifted to Apex Hospital the same day.

He passed away during treatment on 28.10.2020.

The applicant claimed medical reimbursement of approximately ₹1,40,000.

The respondents rejected the claim vide order dated 14.12.2020, primarily on the technical ground that the department was not informed of the hospitalization within the prescribed 24-hour window, preventing a nodal officer's visit.

The applicant challenged this rejection, citing her status as an elderly lady unaware of technical rules during a life-threatening emergency.

1. Whether the medical reimbursement claim of a retired employee can be rejected solely on the technical ground of failure to intimate the department within 24 hours of emergency hospitalization.

2. Whether the "factum of treatment" outweighs procedural technicalities in matters of life-saving medical care.

The right to medical facilities for government employees and retirees is a fundamental right that cannot be fettered by technicalities.

Statement on the doctrine derived from Shiva Kant Jha v. Union of India (2018) 16 SCC 187: emphasizing that the "real test" for reimbursement is the factum of treatment supported by records, and claims cannot be denied if the patient was admitted under emergency conditions where survival is the prime consideration, regardless of whether the hospital is empanelled or prior permission was obtained.

The Tribunal observed that the applicant’s husband was admitted under emergent conditions and passed away within 48 hours, highlighting the gravity of the situation.

It held that expecting an elderly caregiver to prioritize departmental intimation within 24 hours while the spouse's life was at stake is unreasonable.

The Tribunal reasoned that once the factum of treatment is established, the administration must adopt a responsive, welfare-oriented approach rather than a mechanical or "inhuman" one.

While the respondents raised concerns regarding documentation deficiencies (missing dates/signatures), the Tribunal noted that the primary reason for rejection was the lack of timely intimation, which it deemed an invalid ground for outright denial in an emergency.

The Tribunal directed the applicant to submit fresh claim papers and ordered the respondents to: (i) communicate any specific deficiencies in the bills to the applicant; (ii) grant reasonable time for rectification; and (iii) process the reimbursement claim within four months of submission.

No order as to costs was made.