Delhi High Court Rules Full Reimbursement for Emergency Treatment at Non-Empanelled Hospitals

New Delhi: The Delhi High Court has clarified that during a medical emergency, the Central Government cannot deny full reimbursement of treatment costs to beneficiaries of the Central Government Health Scheme (CGHS), even if treatment is received at a non-empanelled hospital outside the CGHS panel. The Court upheld the Central Administrative Tribunal (CAT) order, directing the government to pay the claimant ₹2.82 lakh with interest.

Background of the Case

The case arose when Kamal Kishore, a retired government employee and CGHS beneficiary, received emergency treatment at UK Nursing Home Multi-Speciality Hospital on 11th November 2020 during the COVID-19 pandemic. The hospital was not part of the CGHS panel, and the charges exceeded the standard rates notified by the Delhi Government.

Court Decision

A bench of Justice Naveen Chawla and Justice Madhu Jain dismissed the government’s plea against the CAT ruling dated 20th December 2024, which had ordered the reimbursement of ₹2,82,111 with interest to Kamal Kishore.

The High Court emphasized that neither the fixed rates under CGHS nor the empanelment status of hospitals can prevent reimbursement in cases where treatment was medically necessary during an emergency and the expenses were actually incurred by the beneficiary.

Government’s Obligation

The Court rejected the government’s argument that UK Nursing Home was not part of the CGHS panel or that the charges exceeded Delhi Government rates, noting that such claims cannot absolve the government of its liability. Full reimbursement is guaranteed for emergency care, ensuring patients are not financially penalized for urgent medical needs.

This verdict reinforces the rights of CGHS beneficiaries to receive necessary emergency care without worrying about bureaucratic restrictions or hospital empanelment.