Family Pensioner Cannot Be Treated As 'Dependent' To Deny Medical Reimbursement: Uttarakhand High Court

The Uttarakhand High Court has held that a recipient of family pension cannot be treated as a “dependent” for the purpose of denying medical reimbursement under applicable Government Orders, particularly where the benefit is claimed in an independent capacity. The Court observed that once the State has extended the benefit of a health scheme to a family pensioner and continued to deduct contributions, it cannot subsequently deny reimbursement on the ground of age restrictions applicable to dependents. On this basis, the Court quashed the rejection of a medical reimbursement claim and directed payment with interest.

Justice Pankaj Purohit allowed a writ petition filed by a woman whose claim for reimbursement of medical expenses incurred at AIIMS, New Delhi had been rejected on the ground that she was above 25 years of age at the time of treatment.

The petitioner is the daughter of a deceased government employee and was granted family pension after the death of her mother in 2020. She was also issued a Golden Card under the State Government Health Scheme, with regular deductions being made from her pension towards the scheme.

In 2021, the petitioner met with an accident and underwent treatment at AIIMS, New Delhi. While two smaller claims were reimbursed, a major bill amounting to ₹4,29,561/- was rejected through a communication dated 03.02.2024 on the ground that she was above 25 years of age and therefore not entitled to reimbursement under the relevant Government Orders.

The petitioner contended that the rejection of her claim was based on a misinterpretation of the applicable Government Orders, which apply to dependents of government employees, whereas she was claiming reimbursement as a family pensioner in her own independent right.

It was further submitted that once she had been issued a Golden Card and contributions were being deducted from her pension, her entitlement under the scheme stood established. The petitioner also relied on the fact that the respondents had already reimbursed part of her claim, thereby acknowledging her eligibility under the scheme.

The respondents contended that as per the applicable Government Orders, medical reimbursement is not admissible to dependents above 25 years of age, and since the petitioner was about 29 years old at the time of treatment, her claim was rightly rejected.

It was also submitted that there was ambiguity regarding her status and that sufficient documents had not been furnished at the time of processing the claim.

The Court noted that the controversy lay in a “narrow compass” whether a family pensioner could be denied reimbursement by treating her as a dependent under the Government Orders.

“At the outset, the foundational premise adopted by the respondents for rejecting the petitioner's claim is legally unsustainable”,the Court said, as the petitioner, being a family pensioner, was a beneficiary in her own independent right and could not be equated with a dependent.

The Court further observed that the petitioner had been issued a Golden Card and contributions towards the scheme were being regularly deducted from her pension. In such circumstances, denial of reimbursement was held to be arbitrary and violative of Article 14.

It further noted the inconsistency in the respondents' stand, as part of the claim had already been reimbursed, and found no dispute regarding the treatment, Essentiality Certificate, or genuineness of the claim.

Consequently, the High Court quashed the impugned communication rejecting the claim and directed the respondents to release the medical reimbursement amount along with interest at 5% per annum from the date of entitlement till actual payment.

The writ petition was accordingly allowed.

Case Name: Karishma Bhatt v State of Uttarakhand and Ors

Case No. : Writ Petition Misc. Single No. 1113 of 2024

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