In Brief
A retired government pensioner, aged over 70, was denied full reimbursement of emergency cardiac treatment costing over Rs. 13 lakhs under CGHS, as the hospital was not empanelled and prior approval had not been obtained. The Supreme Court held that when a patient requires emergency life-saving treatment, procedural requirements cannot override medical necessity. The Court directed payment of the balance amount owed and established that the factum of treatment, not technical compliance, is the test for reimbursement. The Court also mandated that all pension-related medical claims must be reimbursed within one month and established a high-powered committee for grievance redressal to prevent harassment of elderly beneficiaries.
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