The Delhi High Court has ruled that an employee is entitled to claim medical reimbursement even if the treatment was obtained from a hospital not empanelled under the Central Government Health Scheme (CGHS), provided the admission occurred during an emergency. Justice Jyoti Singh while considering the case filed by Seema Mehta Vs GNCT of Delhi & Ors, held that the petitioner could not be denied reimbursement due to her inability to approach CGHS-empanelled hospitals during a critical medical emergency.

Case Background

The petitioner, employed at an aided school since 2000, suffered a severe road accident on September 18, 2013, which resulted in critical head injuries. Initially admitted to Guru Tegh Bahadur Hospital in Shahdara, she was later referred to Sir Ganga Ram Hospital (SGRH) due to the severity of her condition. After undergoing major brain surgery and subsequent treatments, she was finally discharged in January 2014. A medical fitness certificate was issued on March 1, 2014, followed by an emergency certificate dated October 11, 2017.

The petitioner claimed reimbursement of Rs.5,85,523 for her medical expenses, but her request was denied by the school authorities and the Directorate of Education (DoE). Aggrieved, she approached the High Court.

Petitioner’s Contentions

The petitioner argued that, as an employee of an aided school receiving government funding, both the school and the DoE were responsible for reimbursing her medical expenses. Citing precedents such as Milap Singh v. Union of India and Anr. (2004) and Ram Kumar Kaushik v. Govt. of NCT of Delhi and Ors. (2016), her counsel contended that reimbursement should not be denied solely because the hospital was not CGHS-empanelled, especially in an emergency.

Respondents’ Contentions

The DoE countered that the petitioner had failed to approach CGHS-empanelled hospitals during the emergency. They also argued that the petitioner’s accident occurred four years before the emergency certificate was issued, and that her termination following disciplinary proceedings barred her from claiming reimbursement. The school maintained that it had acted on the DoE’s directions and bore no independent liability.

Court’s Findings

The Court identified the key issue as whether the petitioner could be denied medical reimbursement because she did not seek treatment from a CGHS-empanelled hospital. Observing the emergency certificate issued by SGRH’s Vice Chairman and Senior Consultant in Neurosurgery, the Court found the certificate’s authenticity unquestionable.

Referring to Shiva Kant Jha v. Union of India (2018), the Court noted:
"When an employee is admitted to a hospital in emergency condition, law does not require prior permission where survival of the person is the prime consideration."

The Court also cited Union of India and Another v. Joginder Singh (2023), emphasizing that medical claims for emergency treatment should not be denied solely because the hospital was not empanelled. It held, “Preservation of human life is of paramount importance... Denying timely treatment would amount to a violation of Article 21 of the Constitution.” Considering the circumstances, the Court concluded that the petitioner, admitted under emergency conditions following a road accident, could not be denied reimbursement. It further held that the delay in issuing the emergency certificate did not invalidate her claim.

Judgment

The High Court allowed the appeal, directing the respondents to reimburse Rs.5,85,523 within six weeks. Additionally, it awarded the petitioner interest at 6% per annum from the date of rejection of her claim to the actual date of payment.

Cause Title: SEEMA MEHTA V/S GNCT OF DELHI AND ORS

Case No: WP(C) 10708//2029 & CM APPL. 46118/2022

Date: November-26-2024

Bench: Justice Jyoti Singh

[Read/Download order]