Dehradun: The Uttarakhand High Court has ruled that a family pensioner cannot be denied medical reimbursement under state health schemes. Justice Pankaj Purohit quashed the rejection of a Dehradun woman's claim for Rs 4.2 lakh incurred at AIIMS, New Delhi, and directed the payment with 5% interest.
Court's Observation
The single bench observed that "once the state had extended the benefit of a health scheme to a family pensioner and continued to deduct contributions, it could not subsequently deny reimbursement by invoking age restrictions applicable to dependants." The court emphasized that a family pensioner is a beneficiary in her own independent right and cannot be equated with a dependant.
Background of the Case
The petitioner was granted family pension after her mother's death in 2020. She was issued a golden card under the state government health scheme, with regular deductions being made from her pension. In 2021, she met with an accident and underwent treatment at AIIMS, New Delhi. While two smaller claims were reimbursed, the bill of Rs 4.2 lakh was rejected on the ground that she was over 25 years old.
Petitioner's Argument
The petitioner contended that the rejection stemmed from a "misinterpretation" of the applicable government orders (GOs), which applied to dependants, whereas she was claiming reimbursement as a family pensioner in her own independent right. She argued that the issuance of the golden card and continued deductions established her entitlement under the scheme. The petitioner also pointed out that part of her claim had already been reimbursed, indicating acknowledgment of her eligibility.
Respondents' Stand
The respondents argued that under the applicable GOs, reimbursement was not admissible to dependants above 25 years. Since the petitioner was about 29 years at the time of treatment, her claim was "rightly rejected." They also cited ambiguity regarding her status and alleged that sufficient documents had not been furnished.
High Court's Ruling
The High Court noted that the controversy lay in a "narrow compass" -- whether a family pensioner could be denied reimbursement by being treated as a dependant under the GOs. "At the outset, the foundational premise adopted by the respondents for rejecting the petitioner's claim is legally unsustainable," the court observed, holding that "a family pensioner is a beneficiary in her own independent right and cannot be equated with a dependant."
Since the petitioner had been issued a golden card and contributions were being regularly deducted from her pension, denial of reimbursement was "arbitrary" and "violative of Article 14 of the Constitution," the HC observed. It 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.
Order
Accordingly, 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.
