The Delhi High Court has upheld the right of employees to receive medical reimbursement during emergencies, even if the hospital is not empanelled under the Central Government Health Scheme (CGHS).
The ruling came in a case involving Seema Mehta, an aided-school employee, who faced significant medical expenses after a severe accident. Mehta, employed since 2000, suffered critical head injuries in a road accident on18 September, 2013.
Initially admitted to Guru Tegh Bahadur Hospital, she was later transferred to Sir Ganga Ram Hospital for major brain surgery. Despite prolonged treatment and multiple hospitalisations, her recovery was slow. She was finally discharged in January 2014 and declared fit for duty two months later.
Mehta incurred medical expenses amounting to Rs 5.85 lakh. However, her reimbursement claim was denied by the Directorate of Education (DoE) and the school authorities, citing that Sir Ganga Ram Hospital was not CGHS empanelled.
The court examined the case and emphasised that emergency medical situations require immediate action, often leaving no time to adhere to CGHS guidelines or seek prior approval. The survival of the patient, it ruled, takes precedence over bureaucratic procedures.
Given the authenticity of the emergency certificate issued by the hospital, the court deemed it unjust to deny Mehta’s claim. It directed the DoE and the school to reimburse the full amount of Rs 5.85 lakh within six weeks.
The court also mandated an interest payment of six per cent per annum on the reimbursed amount, calculated from the date of initial claim rejection to the final payment date.
This judgment reinforces the principle that emergency healthcare cannot be compromised by procedural barriers, ensuring critical support for employees during life-threatening situations.
