Case Note & Summary
The petitioner, Mrs. Ivy Miller Chahal, aged 75 years, is the widow of late Gurmail Singh Chahal. She filed a writ petition under Articles 226 and 227 of the Constitution of India before the High Court of Karnataka at Bengaluru, seeking quashing of email communications dated 07/10/2024, 20/11/2024, and 04/03/2025 sent by respondent No. 3 (Director, Central Government Health Scheme) and a direction for full reimbursement of the medical claim for CRT-D (Cardiac Resynchronization Therapy Defibrillator) implantation of her late husband. The claim was made on 26/12/2023 and acknowledged by respondent No. 3 vide MRC No. 3559/2023/BNGLR/BA04. The respondents denied the claim on the ground that CRT-D implantation was not listed in the CGHS rate list. The Court, after hearing the petitioner's counsel Sri. A. Madhusudhana Rao and the respondents' counsel Ms. Swati L. Kamat, observed that the denial of reimbursement for a life-saving treatment on technical grounds is unsustainable. The Court quashed the impugned email communications and directed the respondents to make full reimbursement of the medical claim as per the actual expenditure incurred, within a specified period. The Court emphasized that the right to life and health cannot be defeated by technicalities, and the CGHS scheme must be interpreted liberally to ensure access to life-saving treatments.
Headnote
A) Medical Law - Medical Reimbursement - Central Government Health Scheme - Life-Saving Treatment - Denial on Technical Grounds - The petitioner sought reimbursement for CRT-D implantation of her late husband, which was denied by respondents on the ground that the procedure was not listed in the CGHS rate list. The Court held that denial of reimbursement for a life-saving treatment on technical grounds is unsustainable, and directed full reimbursement as per the actual expenditure incurred. (Paras 1-5) B) Constitutional Law - Writ Jurisdiction - Articles 226 and 227 of the Constitution of India - Mandamus - The Court exercised its writ jurisdiction to quash the impugned email communications and issued a writ of mandamus directing the respondents to make full reimbursement of the medical claim, emphasizing that technicalities cannot defeat the right to life and health. (Paras 1-5)
Issue of Consideration
Whether the respondents were justified in denying the medical reimbursement claim of the petitioner for CRT-D implantation of her late husband on the ground that the procedure was not listed in the CGHS rate list, and whether the petitioner is entitled to full reimbursement.
Final Decision
The Court allowed the writ petition, quashed the impugned email communications dated 07/10/2024, 20/11/2024, and 04/03/2025, and directed the respondents to make full reimbursement of the medical claim of the petitioner for CRT-D implantation of her late husband as per the actual expenditure incurred, within a period of four weeks from the date of receipt of a copy of the order.
Law Points
- Medical reimbursement
- Central Government Health Scheme
- life-saving treatment
- CRT-D implantation
- denial on technical grounds
- writ of mandamus
- Articles 226 and 227 of the Constitution of India
