INDIAN COUNCIL FOR AGRICULTURAL RESEARCH Vs PRAMOD NISCHAL
- Citation2025 SCC OnLine Del 343
Ratio decidendi
The rule this decision rests on
Where a CGHS beneficiary requires emergency surgery necessitated by an acute medical condition (such as hip replacement following hip fracture), and is admitted to an empanelled CGHS hospital in emergency circumstances and operated upon immediately thereafter, the beneficiary is entitled to reimbursement of the actual medical expenses incurred rather than reimbursement limited to CGHS rates.
Written by Miss Lucy from the judgment below, not taken from a headnote.
Judgment
As delivered
Government Health Scheme1 beneficiary, whose husband was employed in the Indian Council for Agricultural Research2. He died in harness. Shakuntla Sekhri was in receipt of family pension from ICAR as the widow of her deceased husband.
2.
Ms. Shakuntla Sekhri suffered a fracture on her left hip on 1
October 2021. She was taken to Saroj Hospital, Rohini, Delhi, which is admittedly an empanelled CGHS Hospital. She was admitted in
1
CGHS ICAR Signature Not Verified 2
Signed By:MEENU WP(C) 376/2025 KALRA Signing Date:27.01.2025 13:07:31
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emergency condition and, on the very next day on 2 October 2021, she was operated for total left Hip Replacement. She was discharged on 5 October 2021.
3.
The respondent sought reimbursement of the medical expenses
incurred in the replacement surgery undergone by his mother.
4.
The petitioner granted reimbursement but only at the CGHS
rates.
5.
The
respondent
accordingly
approached
the
Central
Administrative Tribunal3 by way of OA 3606/2022, which stands allowed by the Tribunal vide the impugned judgment dated 27 August 2024. The Tribunal has held the respondent to be entitled to reimbursement of the actual expenses incurred in the treatment and surgery of his mother Shakuntla Sekhri.
6.
Aggrieved thereby, the petitioner is before this Court.
7.
We have dealt with an identical situation in Hira Lal Bhat v
CMD, BSNL4, which, too involved a case of Liver Transplant in which the person was admitted one day and operated on the next. We have followed earlier decisions of this Court in UOI v Joginder Singh5, UOI v Surender Kumar Kaur6, Jasbir Singh v UOI7 and
3
“the Tribunal” 2024 SCC OnLine Del 9065 5 (2023) 3 LLJ 404 (Del-DB) 6 2023 SCC OnLine Del 3414 7 2024 SCC OnLine Del 9 Signature Not Verified 4
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Jagir Kaur v UOI8 in which, in such cases, at least three Coordinate Benches of this Court have held that the actual medical expenses incurred have to be reimbursed.
8.
Hip surgery follows hip fracture.
Ex facie, therefore, hip
replacement is an emergency surgery.
9.
In that view of the matter, we find no reason to interfere with
the impugned judgment of the Tribunal.
10.
The writ petition is accordingly dismissed.
C. HARI SHANKAR, J.
AJAY DIGPAUL, J. JANUARY 20, 2025 ssc Click here to check corrigendum, if any
8 2024 SCC OnLine Del 4698 Signature Not Verified
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