Karnataka HC asks Centre to consider cashless CGHS treatment for medical emergencies

The Karnataka High Court has asked the Union government and Central Government Health Scheme (CGHS) authorities to examine the feasibility of introducing a cashless medical treatment mechanism, particularly for emergency and critical care, after flagging the hardship caused to a retired IAS officer who was made to pay over Rs 15 lakh upfront for her husband’s life-saving heart treatment and then denied reimbursement.

The direction was issued while allowing a petition filed by Ivy Miller Chahal, a 75-year-old retired Indian Administrative Service officer, whose CGHS claim for a cardiac device implanted in her husband was rejected months after the procedure, even as he died during the pendency of the claim. Court held that forcing pensioners to first arrange large sums of money in medical emergencies and then chase reimbursement defeated the very purpose of a welfare health scheme.

Court said the reimbursement-based model under CGHS places an onerous burden on retired government employees, who often have no income beyond pension. Medical emergencies, the court noted, do not permit financial planning or procedural compliance, and expecting families to mobilise lakhs of rupees at short notice results in avoidable distress, delayed treatment, and prolonged litigation.

Mrs. Chahal’s husband, a former executive director with the Madhya Pradesh Tourism Development Corporation, had a long history of cardiac illness and had undergone two bypass surgeries. In April 2023, he was rushed to Narayana Institute of Cardiac Sciences in Bengaluru with severe cardiac distress, where doctors found that his heart’s pumping capacity had fallen to 20 per cent and placed him on heart failure management.

In October 2023, his condition deteriorated again. Treating cardiologists advised implantation of a Cardiac Resynchronization Therapy Defibrillator (CRT-D) to protect against sudden cardiac death. The device was implanted on October 31, 2023. Mrs. Chahal incurred an expense of Rs 15.30 lakh, including more than Rs 13 lakh for the device, and submitted a reimbursement claim to CGHS in December 2023.

Despite the claim being acknowledged, no decision was taken for several months. In March 2024, while the reimbursement remained pending, her husband suffered another medical emergency and died. It was only in October 2024 that CGHS rejected the claim, citing expert opinion that the CRT-D implantation was “not justified” as an emergency procedure.

The bench of Justice Suraj Govindaraj took strong exception to this approach, holding that officials who were neither present at the time of treatment nor responsible for the patient’s care could not retrospectively sit in judgment over medical decisions taken by specialists in an emergency. Court observed that it was likely the CRT-D implantation itself enabled the patient to survive for several months.

Relying on the Supreme Court’s judgment in Shiva Kant Jha v. Union of India, the high court reiterated that CGHS is a welfare measure intended to ensure that government employees and pensioners are not left without medical care after retirement. Denial of reimbursement for emergency, life-saving treatment despite eligibility under the scheme, the court said, violates the right to life and health under Article 21 and is arbitrary under Article 14.

Quashing the emails rejecting the claim, court directed the Union government to make full reimbursement of the medical expenses incurred by the petitioner within 30 days, along with interest at 12 per cent per annum from the date the payment was made.

Beyond granting individual relief, court described the absence of a cashless treatment mechanism as a systemic failure. It directed CGHS authorities to consider, at the appropriate administrative level, phased implementation of cashless treatment for emergency and critical care, noting that such a framework would reduce disputes, prevent financial hardship, and align the scheme more closely with constitutional values.

A welfare State, the court held, cannot allow a situation where a retired government servant is forced to choose between saving a spouse’s life and facing financial collapse.

Case Title: Mrs Ivy Miller Chahal

Order Date: December 3, 2025

Bench: Justice Suraj Govindaraj