Court Pulls Up CGHS for Systemic Lapses
Criticising prolonged delays in clearing medical reimbursement claims of retired employees, the Punjab and Haryana High Court has directed the Central Government Health Scheme (CGHS) to frame a comprehensive Standard Operating Procedure (SOP) for processing such claims in a time-bound and transparent manner.
Rs 1 Lakh Cost Imposed on PSPCL
Taking a stern view, Justice Harpreet Singh Brar imposed a cost of ₹1 lakh on the Punjab State Power Corporation Limited (PSPCL) for what the court termed an “inordinate, unreasonable and undignified” delay in settling a retiree’s medical reimbursement.
Case Involves Retired Employee’s Medical Claim
As reported, the case pertained to a retired employee who had spent over ₹3.69 lakh on his wife’s medical treatment. Despite submitting all required documents, the reimbursement claim remained pending for a prolonged period, causing undue harassment to the petitioner.
Delay Not Retiree’s Responsibility: HC
The delay occurred after the Health and Family Welfare Department sought an item-wise breakup of the hospital package. However, the court categorically held that procuring such details was not the responsibility of the retired employee.
Strong Observations by the Bench
During the hearing, the court observed that long years of service entitled the petitioner to timely reimbursement of medical expenses. “Denying him this right by taking an insensitive and lackadaisical approach cannot be condoned by this court in any way,” Justice Brar remarked.
Directive to Frame Comprehensive SOP
To prevent recurrence of such cases, the High Court directed the CGHS Director to frame a detailed SOP covering the entire reimbursement process. The SOP must clearly outline procedures for submission, verification, and approval of medical bills.
Timeline and Accountability Fixed
The court said the policy should also specify the list of required documents, issuing authorities, and may prescribe a fixed timeline for disbursement of claims. The CGHS has been given three months to prepare the SOP and submit an affidavit confirming compliance.
MoU Binding on Authorities: Court
Justice Brar further clarified that since a Memorandum of Understanding (MoU) existed between the corporation and the hospital prescribing CGHS package rates, authorities could not deviate from it. Any lapse on the hospital’s part could not be used to deny or delay reimbursement to the retiree, the court ruled.
