Rules, Rights & Rites -78
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In the case of ANIRUDH PRATAPRAI NANSI vs. THE UNION OF INDIA & ORS. Under WRIT PETITION NO. 7546 OF 2022 , the HIGH COURT of BOMBAY, Pronounced judgment on 6th June 2025
• The petitioner, a retd Govt employee suffered from Cardiomyopathy since 2009 and underwent heart transplant due to significant deterioration in October 2019.
• At the time, neither Government Hospitals nor CGHS-empanelled super-speciality hospitals in Mumbai were performing heart transplant surgeries.
• Petitioner sought treatment at Sir H. N. Reliance Foundation Hospital, a non-empanelled hospital, due to the critical nature of his condition and lack of alternatives.
• He claimed reimbursement in December 2020, for Rs. 29,96,020.35/-.
• Petitioner's claim for full reimbursement was rejected by Additional Director General, CGHS New Delhi on November 30, 2021.
• The treatment was elective, undertaken with prior permission stating reimbursement would be at CGHS rates, and did not fall under criteria for full reimbursement under relaxation of rules.
• Petitioner challenged this rejection in a previous Writ Petition, leading to the case being placed before the High Power Committee (HPC).
• High Power Committee meeting was held on March 30, 2022.
• HPC opined that full reimbursement was not recommended because the Beneficiary was supposed to follow CGHS permitted rates and the procedure was a planned surgery and not an emergency. and reimbursement had already been done as per CGHS extant rules and guidelines.
• It was informed reimbursement would be at CGHS rates for non-empanelled hospitals, with the excess to be borne by the patient.
• The impugned decision denying full reimbursement is quashed and set aside and directed to sanction and grant reimbursement of Rs. 22,08,440/- with interest thereon at 9% per annum which should be done within four weeks from the date of judgment.
• The Court observed in the Office Memorandum dated July 15, 2014 provides for relaxation of procedures for medical reimbursement in special cases, peculiar circumstances, and emergencies, including "any other special circumstances."
• Even without specific guidelines, the Central Government has executive powers (under Article 73 of the Constitution) to consider special cases for medical reimbursement, especially for serious treatments.
• Right to life (Article 21) includes the right to health and to avail necessary life-saving treatment.
• Rules governing reimbursement are not sacrosanct and should allow for discretion in exceptional/special/deserving cases.
• The Court emphasized that denying full reimbursement, especially when the treatment and expenditure are undisputed and genuine, is a "travesty of justice" and a "glaring violation of fundamental rights."
• HPC should have been "humanely sensitive" instead of adopting a "mechanical and narrow-minded approach."
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