Is Medical Reimbursement for Emergency Hospitalisation Allowed Even if the Hospital Is Not Empanelled?

A recent judgment of the Delhi High Court in Union of India & Ors. v. Kamal Kishore (2025) has reaffirmed that when a patient is admitted under genuine emergency conditions, the government cannot limit or refuse medical reimbursement because the hospital was not empanelled or that the costs went beyond CGHS-notified rates.

Introduction

Healthcare emergencies rarely wait for administrative formalities. When life is at risk, a patient’s priority is survival—not whether the hospital happens to be listed under a government scheme. Yet, after recovery, many government employees face unexpected hurdles when seeking reimbursement for treatment undertaken at private, non-empanelled hospitals.

The Central Government Health Scheme (CGHS) and similar frameworks prescribe empanelled hospitals and package rates. However, judicial decisions have consistently held that technicalities cannot override the constitutional right to life and health under Article 21, which includes the right to receive timely medical care.

The 2025 Delhi High Court ruling once again emphasised this constitutional protection and clarified the extent to which government authorities must reimburse medical expenses incurred in emergencies—even beyond CGHS rates and even in non-empanelled facilities.

Factual Background of the Case

The respondent, Kamal Kishore, a retired Private Secretary from the Ministry of Tourism and a CGHS beneficiary, contracted COVID-19 during the peak of the pandemic. On 11 November 2020, he developed acute respiratory distress and had to be immediately admitted to U.K. Nursing Home Multi-Speciality Hospital, New Delhi, a non-empanelled facility, because no beds were available in empanelled CGHS hospitals.

He remained hospitalised, including in the ICU, until 10 December 2020, incurring a bill of ₹7,20,911. The hospital also issued an Emergency Certificate, confirming that immediate admission was medically necessary.

While the government reimbursed a portion of the expenses (approximately ₹4,38,805), the balance ₹2,82,111 was denied on the grounds that reimbursement cannot exceed CGHS/GNCTD-approved package rates. The authorities insisted that private hospitals treating COVID-19 were bound by fixed package rates issued by the Delhi Government.

Aggrieved, the respondent approached the Central Administrative Tribunal (CAT), which directed full reimbursement. The Union of India challenged this before the Delhi High Court. The High Court dismissed the government’s writ petition and upheld the Tribunal’s order.

What the Delhi High Court Held

The Court held that once emergency treatment is established, reimbursement cannot be restricted merely because:

• the hospital was not empanelled, or
• the hospital charged more than CGHS/GNCTD-prescribed rates.

The Court relied heavily on established Supreme Court jurisprudence, holding that:

During medical emergencies, rate fixation norms and empanelment lists cannot impede a patient’s right to treatment and reimbursement.

Key Observations

The Court made the following significant observations:

(i) Emergency overrides rate restrictions

Rigid adherence to package rates is impermissible when treatment is proven to be emergent. The hospital’s charges, even if above government-notified rates, cannot be grounds for denying reimbursement to the patient.

(ii) Non-empanelment is irrelevant in emergencies

The Court referred to the Supreme Court’s landmark judgment in Shiv Kant Jha v. Union of India (2018), which held:

• The right to medical reimbursement cannot be denied merely on the ground that the hospital was not on the approved list.
• Authentic records showing actual treatment are sufficient.

(iii) Burden to regulate hospital charges lies with the State, not the patient

If hospitals violate government pricing norms, the State may proceed against the hospital, but cannot penalise the patient:

“Whether the hospital overcharged is a matter for the authorities to take up with that hospital. The respondent cannot be penalised.”

(iv) Article 21 guarantees access to health care

The Court reiterated that:

“Preservation of human life is of paramount importance. Denial of medical claims in emergencies violates Article 21.”

(v) The Government's duty continues even after retirement

Retired employees cannot be deprived of adequate medical reimbursement, since CGHS is a welfare scheme rooted in constitutional obligations.

(vi) Technical objections cannot defeat substantive rights

Objections such as:

• hospital not empanelled,
• rates exceeded,
• absence of prior permission

were held invalid in emergencies.

Supreme Court Precedents Supporting the Right to Full Reimbursement

Indian courts have consistently held that medical reimbursement must prioritise life, not bureaucracy. The Delhi High Court reaffirmed principles laid down in:

(A) Surjit Singh v. State of Punjab (1996)

Supreme Court held that:

• A government employee must receive timely medical care.
• Reimbursement cannot be denied merely for not obtaining prior approval.

(B) State of Punjab v. Mohinder Singh Chawla (1997)

• The right to health is part of Article 21.
• The government has an obligation to reimburse life-saving treatment.

(C) Shiv Kant Jha v. Union of India (2018)

The Supreme Court’s most authoritative pronouncement:

• Hospitals not appearing in CGHS lists cannot be a ground to deny reimbursement.
• In emergencies, refusal of reimbursement is “inhuman”.

These cases illustrate that medical reimbursement disputes must be resolved with humanity, fairness, and respect for constitutional rights—not bureaucratic rigidity.

Conclusion

The answer to the central question—Is medical reimbursement for emergency hospitalisation allowed even if the hospital is not empanelled?—is an unequivocal YES, as reaffirmed by the strong judicial reasoning in the Delhi High Court’s 2025 judgment in Union of India v. Kamal Kishore.

The Court made it clear that emergency medical care must prevail over bureaucratic restrictions, and reimbursement cannot be denied merely because the treatment was taken in a non-empanelled hospital or because the expenses exceeded CGHS-prescribed rates.

It emphasised that rate caps cannot be allowed to restrict a patient’s access to life-saving treatment, and technical objections should never be permitted to defeat the constitutional guarantee of the right to life and health under Article 21. Ultimately, the judgment reiterated that government authorities are expected to act with sensitivity, fairness, and humanity, particularly when a patient's life has been at stake.

Important Link

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