A Landmark Judgment for Pensioners' Right to Life and Medical Reimbursement

 

 CGHS AT A GLANCE.BLOGSPOT.COM /007/E                         Date 07/06/25

 💓 A Landmark Judgment for Pensioners' Right to Life and Medical Reimbursement

🏛️ Case: Anirudh Prataprai Nansi vs Union of India & Others

Writ Petition No. 7546 of 2022

Bombay High Court – Judgment dated 6 June 2025

Coram: Justices G.S. Kulkarni & Advait M. Sethna

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 ✍️ Background of the Case

    Mr. Anirudh Prataprai Nansi, a retired Assistant Commissioner from the Central Excise and Customs Department, took voluntary retirement in 2008. A senior citizen and a CGHS beneficiary, he was living in Mumbai and unfortunately diagnosed with cardiomyopathy—a life-threatening condition that severely weakened his heart 💔.

    Doctors advised a heart transplant – a major surgery requiring highly specialized care and immediate action upon organ availability. However, none of the CGHS-empanelled hospitals in Mumbai were performing heart transplants at that time.

    Faced with the urgent need to save his life, Mr. Nansi got treated at Sir H. N. Reliance Foundation Hospital, a private (non-empanelled) hospital. The surgery was successful 🎉, but the bill was nearly ₹30 lakh. He claimed medical reimbursement from CGHS under “special circumstances”.

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🧾CGHS Response: Rejection and Red Tape

    Initially, CGHS reimbursed only ₹1.6 lakh 😞 based on old package rates (₹69,000) applicable to Mumbai under CGHS rules. They cited:

• The hospital was not empanelled ❌
• The surgery was "planned", not an "emergency" 🚫
• Mr. Nansi had accepted the reimbursement condition earlier 

Even when he wrote multiple letters and even filed RTIs, the CGHS refused to budge. He approached the High Power Committee (HPC), but it too rejected his full reimbursement claim without giving him a personal hearing.

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   ⚖️ Petitioner Moves the Bombay High Court

Frustrated with CGHS's rigid approach, Mr. Nansi filed Writ Petition No. 7546 of 2022 in the Bombay High Court 🏛️. His main arguments:

• He was denied full reimbursement despite his case being urgent and life-saving.
• No CGHS hospital in Mumbai could offer the transplant.
• He was forced to go to a private hospital with an available donor to save his life 💓.
• CGHS had allowed higher rates for heart transplants in other cities like Delhi (₹3.17 lakh), but not Mumbai, which was discriminatory

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The Court's Observations and Findings

The Bench, led by Justice G.S. Kulkarni, gave a strongly worded judgment in favor of the petitioner. Here’s what the Court held:

✅ 1. Heart Transplant is Not Routine

• It’s a critical and life-saving surgery, not something one plans for convenience.
• It qualifies as “special circumstances”, eligible for full reimbursement.

✅ 2. No CGHS Hospital Could Help

• At the time of surgery, no CGHS hospital in Mumbai had the required license or facility.
• It was unfair to ask the petitioner to go to another state for treatment.

✅ 3. Right to Life Includes Right to Timely Healthcare The Court invoked Article 21 of the Constitution and said:

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• “Denying reimbursement in such cases violates the Right to Life. Health is not a luxury—it’s a fundamental right.” 💪

✅ 4. Reimbursement Rules Are Not Untouchable

• Rules must be flexible in genuine and deserving cases.
• High Power Committee acted in a mechanical way, failed to apply human sensitivity.
• Even without specific provisions, the government has the power to relax rules in extraordinary cases.

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🎉 🎉 Final Verdict: A Huge Win for the Petitioner

The Court allowed the writ petition and ordered:

✅ Full reimbursement of ₹22,08,440/- to the petitioner

✅ Interest @ 9% per annum

✅ To be paid within 4 weeks

✅ Strong rebuke to CGHS for technical and insensitive handling of a life-or-death case

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Why This Judgment Matters

This is not just a win for Mr. Nansi – it is a victory for every CGHS pensioner and senior citizen who may face a similar medical emergency in the future.

 Key Takeaways for Readers:

🔹 You can seek full reimbursement even from non-empanelled hospitals in life-threatening cases

🔹 CGHS rules are not rigid; courts can direct relaxation in deserving cases

🔹 Right to Life (Article 21) protects your right to urgent healthcare

🔹 Government cannot deny treatment access just because you are retired or old

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                     🙏 Final Words

This judgment is a ray of hope 🌟 for pensioners who are often left helpless by technicalities. It reminds government authorities that their duty is not just to follow rules, but to serve people with compassion and fairness. 💐.

If you or someone you know is struggling with a similar CGHS claim, do not give up. This case proves that justice is possible – and it might save a life.

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    I kindly request all members and readers to go through this post and share your valuable views, suggestions, or questions in the comments section below. Your feedback will help improve the content and make it more useful for everyone.

Regards,

Chandra Kant Bapat

National Coordinator, CBWAI