News Update

Income tax refund surpasses Rs 1.7 lakh crore in current fiscalGST - An agenda for reforms - Part - 71- Drafting sustainable provisions in GST lawST - Supply of packaged software to end user & charging license fee, results in transfer of right to use software - Such transaction is deemed sale as per Article 366(29A) & will not attract service tax: CESTATCus - In the proceedings under Customs Act, 1962, CHA has been cleared of all allegations - foundation of allegation having failed, forfeiture of security deposit cannot sustain: CESTATCX - Claim for Cenvat credit is not absolute - Assessee must prove receipt, storage & use of inputs/capital goods to manufacture final products or intermediate items used in final products, to justify claim: CESTATCus - Adjudication process cannot be interfered with as it is left on discretion of authorities concerned & with expectation that applicable rules & laws would be followed: HCRe-opening of assessment is invalid if based on change of opinion & where no clarifications are sought from assessee within 4-year limitation period: HCIf AO deals with assessee's objections to re-assessment point by point, it does not entail that presumption of validity of reasons to believe, have been rebutted by assessee: HCExpenditure incurred on daily basis, on account of legal assistance sought, is to be treated as revenue in nature: HCAdditions framed u/s 68 are not tenable if based solely on statements not corroborated by further evidence & without permitting cross examination of the deponents: HCIf scheme of merger is approved & assets of amalgamating company are transferred, then amalgamated company is eligible for depreciation on goodwill under Explanation 3(b) to Sec 32(1): ITATAP Assembly votes for abolition of Legislative CouncilWest Bengal Assembly joins list of States to pass resolution against CAACBIC can help perk up India's EoDB ranking: MoSAdvance Estimates of 2019-20 pegs Horticulture Crops at 313 MTForeign bodies have no locus standi to interfere in India's internal affairs: NaiduIndia-Brazil set target of USD 15 billion trade by 2022: GoyalCBDT extends ad hoc appointment of 176 ACITsFortified rice kernels are correctly classifiable under HSN 1904 9090 [GST @18%] as Prepared foods and not under HSN 1006 1090 as Rice-Others: AARBank Unions resolve to go on strike from Jan 31Ancillary services like Elephant Ride, Guide charges, Boat ride provided to Tour operators are Support Services classifiable under SAC 9985 and attract GST @18%: AARReady to eat 'Fried Fryums' is not 'Papad' but classifiable under heading 2106 and attracts GST @18%: AARMandi Board is not a government authority - Parking lot services provided by applicant to Market Committee at Jalandhar is not exempted; attracts GST @18%: AARGovt decides to offload 100 % equity in Air IndiaGadkari says three expressways costing Rs 3 lakh crore to be ready in 3 yearsNagging issues under SVLDRSST - On death of sole proprietor, appeals and demand and recovery proceedings against appellant abate: CESTATConundrum of reimbursement of expenditure under GST laws!GST on waste disposal: Take care of 'health care'Kolkata DRI seizes 10 kg smuggled gold + 429 kg silver + Rs 20 lakh IC; arrests two personsTIOL wishes All Netizens a very Happy Republic Day & also International Customs Day!Padma Awards - Mary Kom, Manohar Parrikar, Ekta Kapoor & Kangana Ranaut figure in Lists28 CBIC officers & other personnel receive Presidential Award
 
Mega relief for pensioners - SC rules CGHS beneficiaries not to be denied reimbursement for hospitalization expenses in emergency

BY TIOL News Service

NEW DELHI, APR 13, 2018: THE issue before the Apex Court in this case is whether CGHS beneficiaries can be denied reimbursement where they receive treatment in private hospitals in emergency circumstances. NO is the verdict.

Facts of the case

The petitioner is a beneficiary of the Central Government Health Scheme (CGHS). He is entitled to receive treatment in private ward for life. He filed two bills claiming reimbursement of expenses incurred during treatment received in two private hospitals. Suffering from cardiac ailments, he had a CRT-D device implanted. Later, the Technical Standing Committee rejected the first bill without giving reasons for rejecting it. Later it claimed that the petitioner did not require the CRT-D device. Later, the Committee observed that its approval was not sought for receiving implant of such device. Thereupon, the petitioner approached the Director General of the CGHS, after which a sum of about Rs 5 lakhs was credited to his account. However no speaking order was communicated to the petitioner in this regard. Regarding the second set of bills, the petitioner's claim was restricted to one-fourth of the original amount claimed. Such order too was passed without granting opportunity of personal hearing. Hence in totality for both bills, the petitioner received less than half of the total expenses incurred out of his own resources. Although in an interim order, this Court had directed disbursement of Rs 3 lakhs to the petitioner, the present writ was filed, highlighting the petitioner's advanced age and need for funds to continue treatment.

On hearing the matter, the Apex Court was of the view that,

++ It is a settled legal position that the Government employee during his life time or after his retirement is entitled to get the benefit of the medical facilities and no fetters can be placed on his rights. It is acceptable to common sense, that ultimate decision as to how a patient should be treated vests only with the Doctor, who is well versed and expert both on academic qualification and experience gained. Very little scope is left to the patient or his relative to decide as to the manner in which the ailment should be treated. Speciality Hospitals are established for treatment of specified ailments and services of Doctors specialized in a discipline are availed by patients only to ensure proper, required and safe treatment. Can it be said that taking treatment in Speciality Hospital by itself would deprive a person to claim reimbursement solely on the ground that the said Hospital is not included in the Government Order. The right to medical claim cannot be denied merely because the name of the hospital is not included in the Government Order. The real test must be the factum of treatment. Before any medical claim is honoured, the authorities are bound to ensure as to whether the claimant had actually taken treatment and the factum of treatment is supported by records duly certified by Doctors/Hospitals concerned. Once, it is established, the claim cannot be denied on technical grounds. Clearly, in the present case, by taking a very inhuman approach, the officials of the CGHS have denied the grant of medical reimbursement in full to the petitioner forcing him to approach this Court.

++ This is hardly a satisfactory state of affairs. The relevant authorities are required to be more responsive and cannot in a mechanical manner deprive an employee of his legitimate reimbursement. The Central Government Health Scheme (CGHS) was propounded with a purpose of providing health facility scheme to the central government employees so that they are not left without medical care after retirement. It was in furtherance of the object of a welfare State, which must provide for such medical care that the scheme was brought in force. In the facts of the present case, it cannot be denied that the writ petitioner was admitted in the above said hospitals in emergency conditions. Moreover, the law does not require that prior permission has to be taken in such situation where the survival of the person is the prime consideration. The doctors did his operation and had implanted CRT-D device and have done so as one essential and timely. Though it is the claim of the respondent-State that the rates were exorbitant whereas the rates charged for such facility shall be only at the CGHS rates and that too after following a proper procedure given in the Circulars issued on time to time by the concerned Ministry, it also cannot be denied that the petitioner was taken to hospital under emergency conditions for survival of his life which requirement was above the sanctions and treatment in empanelled hospitals.

++ In the present view of the matter, we are of the considered opinion that the CGHS is responsible for taking care of healthcare needs and well being of the central government employees and pensioners. In the facts and circumstances of the case, we are of opinion that the treatment of the petitioner in non-empanelled hospital was genuine because there was no option left with him at the relevant time. We, therefore, direct the respondent-State to pay the balance amount of Rs. 4,99,555/- to the writ petitioner. We also make it clear that the said decision is confined to this case only.

++ Further, with regard to the slow and tardy pace of disposal of MRC by the CGHS in case of pensioner beneficiaries and the unnecessary harassment meted out to pensioners who are senior citizens, affecting them mentally, physically and financially, we are of the opinion that all such claims shall be attended by a Secretary level High Powered Committee in the concerned Ministry which shall meet every month for quick disposal of such cases. We, hereby, direct the concerned Ministry to device a Committee for grievance redressal of the retired pensioners consisting of Special Directorate General, Directorate General, 2 (two) Additional Directors and 1 (one) Specialist in the field which shall ensure timely and hassle free disposal of the claims within a period of 7 (seven) days. We further direct the concerned Ministry to take steps to form the Committee as expeditiously as possible. Further, the above exercise would be futile if the delay occasioned at the very initial stage, i.e., after submitting the relevant claim papers to the CMO-I/C, therefore, we are of the opinion that there shall be a timeframe for finalization and disbursement of the claim amounts of pensioners. In this view, we are of the opinion that after submitting the relevant papers for claim by a pensioner, the same shall be reimbursed within a period of 1 (one) month.

(See 2018-TIOL-136-SC-MISC)