The Karnataka High Court has stepped in to grant relief to a 75-year-old retired IAS officer after her medical reimbursement claim under the Central Government Health Scheme (CGHS) was rejected for more than a year.
In a strongly worded order, the court held that authorities cannot second-guess doctors on life-saving medical decisions taken during emergencies, especially when a pensioner’s right to health is at stake.
Background of the Case
The petitioner, Mrs. Ivy Miller Chahal, a former Indian Administrative Service officer from the Madhya Pradesh cadre, retired in 2010 and later settled in Bengaluru. As a CGHS beneficiary, she and her husband were entitled to medical benefits under the central scheme.
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Her husband, a senior cardiac patient who had already undergone two bypass surgeries, was rushed to Narayana Institute of Cardiac Sciences in October 2023 after his condition sharply deteriorated. Doctors found his heart functioning at just 20% efficiency and advised immediate implantation of a CRT-D (Cardiac Resynchronization Therapy Defibrillator) device to prevent sudden cardiac death.
The surgery was performed on 31 October 2023 at a cost of ₹15.30 lakh. A reimbursement claim was submitted on 26 December 2023 and acknowledged by CGHS. However, before the claim could be settled, her husband passed away in March 2024.
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Rejection of the Claim
Despite repeated follow-ups, CGHS authorities rejected the reimbursement through a series of emails in October and November 2024 and March 2025. The rejection was based on an expert opinion stating that the CRT-D implantation was “not an emergency” and therefore “not justified”.
Aggrieved, the petitioner approached the High Court, arguing that such a view ignored the medical reality faced by her husband and violated the very purpose of CGHS.
Court’s Observations
Justice Suraj Govindaraj did not agree with the stand taken by CGHS.
“The officers were not present in the emergency ward, nor were they the treating doctors,” the court observed, adding that authorities cannot retrospectively question medical decisions taken to save a patient’s life.
Relying heavily on the Supreme Court’s ruling in Shiva Kant Jha v. Union of India, the court underlined that CGHS is a welfare scheme and not a discretionary benefit.
“The survival of the patient is the prime consideration. Prior approvals and technical objections cannot override emergency medical judgment,” the bench noted.
The court also pointed out that the delay of over one year and the absence of a reasoned order made the rejection arbitrary and unfair.
The judgment emphasised that medical reimbursement is closely linked to the right to life under Article 21 of the Constitution.
Denying reimbursement after a pensioner has already incurred massive expenses for life-saving treatment, the court said, defeats the promise made by the State to its employees.
The judge remarked that it was “probably due to the CRT-D implantation” that the petitioner’s husband survived for several months, and that such treatment decisions cannot be questioned with hindsight.
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Final Decision
Allowing the writ petition, the Karnataka High Court quashed all rejection emails issued by CGHS and directed the authorities to fully reimburse the medical expenses incurred for the CRT-D implantation.
The court ordered that the entire amount be paid within 30 days, along with 12% annual interest calculated from the date the petitioner made the payment.
In a significant direction, the court also asked the government to examine the feasibility of introducing a cashless treatment mechanism under CGHS for emergency and critical care cases, to prevent similar hardships in the future.
Case Title: Mrs. Ivy Miller Chahal v. Union of India & Ors.
Case No.: Writ Petition No. 27013 of 2025
Case Type: Writ Petition (Service / Medical Reimbursement)
Decision Date: 3 December 2025
