Post-retirement medical claims within the CGHS grace period cannot be rejected solely because treatment continued after retirement.

The applicant is the widow of Dinesh Chandra Rai, an Akashvani employee who retired on 30 April 2021 and died of COVID-19 on 22 May 2021.

She sought reimbursement of medical expenses incurred during his treatment, including post-retirement treatment at Gorakhpur Chikitsalaya and Research Centre and BRD Medical College.

The respondents paid ₹722 for expenses before retirement but rejected the balance, treating it as post-retirement expenditure.

The Tribunal noted that the claim was stated as ₹3,96,145 by the applicant and ₹3,96,142 as the unpaid amount in the respondents’ counter-affidavit.

1. Whether the medical reimbursement claim could be rejected solely because treatment continued after the employee’s retirement, where the illness began during service and post-retirement treatment occurred within the three-month period addressed by the applicable Office Memorandum.

2. Whether reimbursement was payable subject to the Office Memorandum’s conditions and verification of the medical bills and applicable rules.

The Ministry of Health and Family Welfare Office Memorandum dated 15 September 2011 provides that treatment taken and expenditure incurred within three months of retirement may be reimbursed, subject to the beneficiary obtaining or applying for a CGHS pensioner card with the required documents and paying the requisite subscription within the specified period.

The Tribunal also considered the respondents’ reliance on the All India Services (Medical Attendance) Rules, 1954, and their position that post-retirement medical coverage was through CGHS.

In State of Punjab v. Mohinder Singh Chawla, (1997) 2 SCC 83, the Supreme Court recognised the importance of medical facilities and the State’s obligation concerning employee health, subject to applicable rules and policy; in Shiva Kant Jha v. Union of India, (2018) 16 SCC 187, it emphasised that genuine medical claims should not be rejected on merely technical grounds where the treatment is established.

The Tribunal found that the post-retirement treatment occurred within three months of retirement and that the illness had commenced while the employee was in service.

Accordingly, the fact that treatment continued after retirement was not, by itself, sufficient to reject the claim.

The respondents had to assess it under the 15 September 2011 Office Memorandum and the applicable rules, including the relevant medical records and the Memorandum’s conditions.

Because the claimed and unpaid amounts differed, the Tribunal also required the amount payable to be determined against the original bills and records.

It directed the competent authority to pay the amount found admissible under the 15 September 2011 Office Memorandum and applicable rules, with interest at 6% per annum, within three months of receiving a certified copy of the order.

The direction was for payment of the amount found admissible, not an unconditional award of the full sum claimed; no costs were awarded.