Retired government employees receiving fixed medical allowance remain entitled to reimbursement for emergency indoor treatment.

The applicant, a retired Office Superintendent, retired from government service on 31 March 2017 and was receiving pension under PPO No. C/DAD/16379/2014.

Since no CGHS dispensary was available at Bathinda or nearby, he opted for Fixed Medical Allowance (FMA) for routine medical treatment.

The applicant was hospitalised at Kalra Super Speciality Hospital, Bathinda, from 17 December 2020 to 28 December 2020 and incurred medical expenses of ₹1,19,867 during the treatment.

He submitted the medical bills to the respondents on 11 June 2021, contending that the treatment was obtained in an emergency during the COVID-19 period when no recognised government hospital was reasonably available.

The respondents declined reimbursement on the ground that retired Central Government employees were not covered by the Central Services (Medical Attendance) Rules, 1944, and that the applicant had already opted for FMA instead of CGHS facilities.

The applicant therefore approached the Tribunal under Section 19 of the Administrative Tribunals Act, 1985, seeking reimbursement of ₹1,19,867 with interest.

1. Whether the Central Services (Medical Attendance) Rules, 1944, are applicable to retired Central Government employees.

2. Whether a retired employee who has opted for Fixed Medical Allowance is entitled to reimbursement for indoor medical treatment.

3. Whether the applicant was entitled to reimbursement for treatment obtained in emergency circumstances.

4. Whether a retired employee who has not opted for CGHS indoor/outdoor medical facilities can claim reimbursement of medical expenses.

The Tribunal applied Section 19 of the Administrative Tribunals Act, 1985, concerning the Tribunal’s jurisdiction over service-related claims.

It considered the Central Services (Medical Attendance) Rules, 1944, and rejected the respondents’ restrictive interpretation that retired employees who receive FMA are categorically barred from medical reimbursement.

The Tribunal relied on its earlier decision in Surinder Mohan v. Union of India & Ors. , O.A. No. 714/2020 and connected matters, which addressed the applicability of the CS(MA) Rules to retirees, reimbursement after opting for FMA, emergency treatment, and the absence of CGHS indoor/outdoor facilities.

It also relied on Shiva Kant Jha v. Union of India , W.P. (C) No. 694/2015, decided on 13 April 2018, Sudershan Kumar Sharma v. Union of India , 2013 (1) SCT 817, and Union of India v. Mohan Lal Gupta & Ors. , decided on 17 January 2018, as authorities supporting reimbursement of genuine medical expenses, particularly where treatment was obtained in emergency circumstances.

The Tribunal found it undisputed that the applicant was a retired government employee, had been granted FMA, had undergone hospitalisation from 17 to 28 December 2020, and had paid ₹1,19,867 towards treatment.

Applying the principles recognised in Surinder Mohan and the cited judicial precedents, the Tribunal held that the applicant’s election of FMA did not, by itself, defeat his claim for reimbursement of expenses incurred for necessary and emergency indoor treatment.

The respondents’ refusal, based solely on the applicant’s retired status, receipt of FMA, and non-enrolment for CGHS facilities, was inconsistent with the settled law on medical reimbursement.

The applicant’s case was therefore held to be squarely covered by the earlier decision in Surinder Mohan .

The payment was directed to be made within six weeks from receipt of the order.

The application was disposed of accordingly, with no order as to costs.