IN THE HIGH COURT OF KERALA AT ERNAKULAM PRESENT THE HONOURABLE MR. JUSTICE AMIT RAWAL & THE HONOURABLE MR.JUSTICE K. V. JAYAKUMAR WEDNESDAY, THE 19TH DAY OF MARCH 2025 / 28TH PHALGUNA, 1946 OP (CAT) NO. 46 OF 2024 AGAINST THE ORDER DATED 25.01.2024 IN O.A. NO.448 OF 2020 OF CENTRAL ADMINISTRATIVE TRIBUNAL, ERNAKULAM BENCH PETITIONER(S)/APPLICANT: SASI K.K., AGED 55 YEARS S/O. KUNJU, ASSISTANT FINANCE AND ACCOUNTS OFFICER, CENTRAL PLANTATION CROPS RESEARCH INSTITUTE, REGIONAL STATION, VITTAL, D.K. DIST. KARNATAKA, NOW WORKING AT INDIAN COUNCIL OF AGRICULTURAL RESEARCH,DCR, PUTTUR, DHARBE, DK DIST. KARNATAKA, RESIDING AT KADUKAPARAMBIL HOUSE, ERAVAKAD, CHITTISSERY P.O., THRISSUR DISTRICT,, PIN - 680301 BY ADVS. S.P.ARAVINDAKSHAN PILLAY N.SANTHA V.VARGHESE PETER JOSE CHRISTO S.A.ANAND K.N.REMYA L.ANNAPOORNA VISHNU V.K. RESPONDENT(S): 1 THE DIRECTOR, CENTRAL PLANTATION CROPS RESEARCH INSTITUTE, KASARAGOD, KUDLU P.O., KASARAGOD DISTRICT, PIN - 671124 2 THE HEAD, CENTRAL PLANTATION CROPS RESEARCH INSTITUTE, OP (CAT) NO. 46 OF 2024 -2- 2025:KER:27446 REGIONAL STATION, VITTAL P.O., D.K. DIST, KARNATAKA, PIN - 574243 3 ADMINISTRATIVE OFFICER, CENTRAL PLANTATION CROPS RESEARCH INSTITUTE, KASARAGOD, KUDLU P.O., KASARAGOD DISTRICT, PIN - 671124 4 SENIOR FINANCE AND ACCOUNTS OFFICER, CENTRAL PLANTATION CROPS RESEARCH INSTITUTE, KASARAGOD, KUDLU P.O., KASARAGOD DISTRICT, PIN - 671124 5 THE SECRETARY, INDIAN COUNCIL OF AGRICULTURAL RESEARCH, KRISHI BHAVAN, NEW DELHI, PIN - 110001 BY ADV. SMT.BHADRA KUMARI K.V. THIS OP (CAT) HAVING BEEN FINALLY HEARD47 ON 19.03.2025, THE COURT ON THE SAME DAY DELIVERED THE FOLLOWING: OP (CAT) NO. 46 OF 2024 -3- 2025:KER:27446 JUDGMENT AMIT RAWAL , J. The present O.P.(CAT) is directed against the decision dated 25.01.2024 of the Central Administrative Tribunal in O.A.No.448 of 2020, whereby the claim of the applicant – petitioner for reimbursement of medical treatment undertaken by his mother and unmarried sister for a genetic disease called osteopetrosis, has been declined. 2. Succinctly the facts in brief for adjudication of the lis are enumerated hereinbelow: Petitioner-applicant is working as an Assistant Finance and Accounts Officer with the department of Central Plantation Crops Research Institute, Regional Station, Karnataka. Despite having his wife and two children his family consists of parents one unmarried sister and one working sister. The parents, unmarried sister and children has been shown as dependents as per the family composition Annexure A2. All the family OP (CAT) NO. 46 OF 2024 -4- 2025:KER:27446 members are suffering from Pycknodisostosis, which is in a common parlance called osteoporosis. One out of fifteen lakh suffers from this genetic disorder called Auto Immune Disorder and has to be very careful in day to day occasions as one fracture would lead to multiple fractures and has to undertake medication. It is contended that the father is a pensioner from the Kerala State Government Service with pension about Rs.18,180/- (Rupees Eighteen thousand one hundred and eighty only), whereas the claim for reimbursement of Rs.3,78,800/- towards the treatment expenses of his mother for the period 26.11.2018 to 25.01.2019 and of his unmarried sister from 30.04.2018 to 24.08.2018 has been rejected vide the impugned order Ext.A6. It is further contended that prior to the passing of the impugned order the department was reimbursing the medical expenses for treatment of the mother and the unmarried sister. Even the father, the pensioner, is also suffering and has not claimed the Central Government OP (CAT) NO. 46 OF 2024 -5- 2025:KER:27446 Health (CGH) Scheme showing all the family members as dependents. 2. Respondents contested the matter and submitted that though as per the Central Services (Medical Attendance) Rules, 1944, parents including adoptive parents, step-mother, sisters, widowed sisters, divorced/abandoned or separated sisters, widowed daughters, divorced/ abandoned/separated daughters, minor brothers, permanently disabled brother, children and step children are fall within the definition of family in Rule 2 of the Appendix XIII, but in the absence of any direct materials that both mother and unmarried sister are dependents particularly the other sister who is working, the medical reimbursement was rejected. 3. Learned tribunal on noticing the contention in paragraph Nos.12, 13 and 14 rejected the claim. 4. Mr.S.P.Aravindakshan Pillay, learned counsel appearing on behalf of the petitioner submitted OP (CAT) NO. 46 OF 2024 -6- 2025:KER:27446 that the order of the tribunal is totally opaque and repugnant for the reason that no plausible and reasonable explanation has come forth in denying the medical reimbursement by taking into consideration the definition of family in Rule 2 of Appendix XIII of the Central Services (Medical Attendance) Rules, 1944. One of the reasoning for rejecting the claim is that the applicant is not the only child of the parents, but has a sister who is employed as a teacher and another brother who is suffering from osteopetrosis. Non availability of the means to take care of the family is wholly justified for the reason that the unmarried sister is also suffering from the same decease and is able to recoup her medical expenses by claiming the medical reimbursement for herself. Father is only getting a pension of Rs.18,180/- plus Dearness Allowances and cannot take care of the other dependents from the members like the mother and the unmarried sister as he himself is a sufferer of the genetic decease. It is not the case that the petitioner at OP (CAT) NO. 46 OF 2024 -7- 2025:KER:27446 any point of time after the retirement of his father had ever submitted a claim for his treatment. The upper financial limit of Rs.9,000/- (Rupees Nine thousand only) in Annexure R1 can be only applied with regard to the medical claim for reimbursement raised by the pensioner himself. 5. On the other hand, Smt.Bhadra Kumari K.V., learned counsel appearing on behalf of the respondents countered the aforementioned arguments by submitting that the reasoning assigned by the tribunal is perfectly legal and justified and do not require any different opinion qua entertaining the present O.P. Petitioner had claimed the medical expenses in respect of his mother and unmarried sister on a number of times amounting to lakhs of rupees, as he himself was the authority to pre-audit all the bills pertaining to the regional station even though the expenditure had been sanctioned by the competent authority. Petitioner’s mother and unmarried sister are not depended upon the OP (CAT) NO. 46 OF 2024 -8- 2025:KER:27446 petitioner but on his father, who was not depended on, and also drawing a pension of Rs.18,180/- (Rupees Eighteen thousand one hundred and eighty only) plus Dearness Allowances. Government of India has issued a direction for determining the dependency kept out for reimbursement as Annexure R1, which categorically states that the income limit for the purpose of providing the CGHS coverage to the family members of the CGHS covered under the Central Government employees to Rs.9,000/- (Rupees Nine thousand only) plus the amount of the dearness relief on the basic pension of Rs.9,000/- (Rupees Nine thousand only) as on the date of the consideration. 6. We have heard learned counsel for the parties and appraised the paper book and of the view that there is force on merit in the submissions. 7. Annexure R1 reads as under: “OFFICER MEMORANDUM Sub: Revision of income limit for dependency for the purpose of providing Central OP (CAT) NO. 46 OF 2024 -9- 2025:KER:27446 Government. Health Scheme (CGHS) coverage to family members of the CGHS covered employees subsequent to implementation of recommendation of the seventh Central pay commission- regarding. The undersigned is directed to say that subsequent to the implementation of the recommendations of the 6th CPC, the income limit for dependency for the purpose of extending CGHS coverage to "family" members of the CGHS covered Central Government employees was enhanced to Rs. 3500/-per month plus the amount of dearriess rellef on the basic pension of Rs. 3500/- as on the date of consideration. 2. With the Implementation of the recommendations of the 7th Central pay commission, the issue of revision of income limit for dependency for the purpose of providing CGHS coverage to family members of the CGHS covered Central Government employees and pensioner CGHS beneficiaries was under consideration keeping in view the amount of minimum pension/family pension fixed by the 7th central pay commission 3. On the basis of the recommendations of the 7th CPC, the Department of Pension and Pensioners' Welfare under Para 5.2 of their OM OP (CAT) NO. 46 OF 2024 -10- 2025:KER:27446 No. 38/37/2016-P&PW (A)(I) dated 4/8/2016, has fixed the amount of minimum pension as Rs. 9,000/-per month and under para 7.1 of this OM the amount of family pension has been fixed as 30% of the basic pay in revised pay structure and shall be subject to a minimum of Rs. 9,000/- per month and maximum of 30% of the highest pay in the Government. Vide Para 7.3 of the aforesaid O.M it has been mentioned that there will be no other change in the provisions regulating family pension. 4. It has been decided, in consultation with the Department of Expenditure, to revise the income limit for the purpose of providing. CGHS coverage to the family members of the CGHS, covered Central Government employees to Rs. 9,000/- plus the amount of dearness relief on basic pension of Rs. 9,000/- as on the date of consideration". 5. As such, all the orders related to the CGHS Rules stand amended to the extent that the income limit for Rs.3500/- per month from all sources Including pension/and family pension stands amended to an income of Rs.9000/- plus amount of the dearness relief om the basic pension of Rs.9000/- as on the date of consideration. The amount of dearness relief as indicated in the income limit stands for the OP (CAT) NO. 46 OF 2024 -11- 2025:KER:27446 amount of dearness relief drawn by a pensioner/family pensioner on the date of consideration and not the amount of dearness relief due on the date of consideration.” 8. This applies to the employees who have undertaken the CGH Scheme. Concededly the father of the petitioner was not a Central Government employee but a State Government, therefore the limit of Rs.9,000/- would not be applicable. It would be axiomatic to extract the definition of family in Rule 2 of Appendix XIII of Rules of 1944. The same reads as under: “APPENDIX XIII CONCESSIONS FOR FAMILIES OF CENTRAL GOVERNMENT SERVANTS 1. Families of Central Government servants are entitled to n. attendance and/or treatment, as defined in the CS (MA) Rules, 1944 and the orders issued thereunder, on the scale and conditions allowed to Government servant himself, subject to such exceptions or restrictions specified herein or in the said rules. Note 1: The provisions of this Appendix apply OP (CAT) NO. 46 OF 2024 -12- 2025:KER:27446 mutatis mutandis to female Government servants also. Note 2: The Authorised Medical Attendant of the family of a Government servant is the same as the Authorised Medical Attendant of the Government servant. Note 3: The family of a Government servant is entitled to receive medical attendance and treatment at the hospital at which the Government servant himself is entitled. A list of hospitals recognised for the purpose of medical attendance and treatment of Central Government servants and members of their families is given in Appendix I. DEFINITION OF FAMILY 2. General Conditions The term 'family' for the purpose of the Central Services (Medical Attendance) Rules, 1944, shall mean a Government servant's wife or husband, as the case may be, parents including adoptive parents, step-mother, sisters, widowed sisters, divorced/abandoned or separated sisters, widowed daughters, divorced/ abandoned/separated daughters, minor brothers, permanently disabled brother, children and step children wholly dependent OP (CAT) NO. 46 OF 2024 -13- 2025:KER:27446 upon the Government servant. Note 1: A member of the family is treated as dependant only if his/her income from all sources including pension/family pension and pension equivalent of gratuity does not exceed Rs. 3,500 p.m. plus dearness relief drawn on basic pension of Rs. 3500 as on the date of consideration. The condition of dependency both in the case of husband or the wife of the Government servant has been dispensed with.” 9. On perusal of the definition of family, it is evident that the sister and the mother falls in the category of dependents. It is a matter of record that all the family members consisting of petitioner and his brother and two unmarried sisters including the mother and the father are suffering from the same very disease which is a genetic disorder, a kind of an auto immune disorder, for which, treatment is required for prevention of further deterioration. During the course of the hearing, Mr.S.P.Aravindakshan Pillay submitted that the OP (CAT) NO. 46 OF 2024 -14- 2025:KER:27446 earlier reimbursement bills, no doubt, have been sanctioned by the competent authority and this fact was examined by the learned tribunal after verifying the files summoned for that purpose. It is not the case of misusing the power, as petitioner has not faced any departmental enquiry or other modes of recovery. 10. The reasoning of the tribunal in our considered view is not justified for the reason that the other unmarried sister, who is also suffering from the very same disease is bearing her own medical treatment and therefore, she cannot through the income derived as a salary offset the medical reimbursement expenses viz- a-viz the mother and other sister. For the reason aforementioned, we set aside the judgment of the Central Administrative Tribunal on the ground that both unmarried sister and the mother falls in the definition of the ‘family’ being dependents and petitioner is entitled to medical reimbursement for their treatment. Impugned order Annexure A6 is hereby OP (CAT) NO. 46 OF 2024 -15- 2025:KER:27446 quashed. O.P.(CAT) is allowed. Respondents are directed to pay the medical expenses within a period of one month from the date of receipt of the certified copy of the judgment. Sd/- AMIT RAWAL JUDGE Sd/- K. V. JAYAKUMAR JUDGE VV OP (CAT) NO. 46 OF 2024 -16- 2025:KER:27446 APPENDIX OF OP (CAT) 46/2024 PETITIONER ANNEXURES ANNEXURE A6 TRUE COPY OF THE ORDER IN F NO.21(1)5(RS&RC)/2019-BILLS ISSUED BY THE RESPONDENT NO.3, DATED 28.07.2020. ANNEXURE A1 TRUE COPY OF THE LETTER OF APPOINTMENT GIVEN TO THE APPLICANT BY RESPONDENT NO.1 DATED 01.06.2010. ANNEXURE A2 TRUE COPY OF THE DECLARATION GIVEN TO THE RESPONDENT NO.1 BY THE APPLICANT DATED 27.04.2019. ANNEXURE A3 TRUE COPY OF THE DISABILITY CERTIFICATE ISSUED BY THE MEDICAL BOARD OF GOVERNMENT MEDICAL COLLEGE, THRISSUR TO THE APPLICANT’S SISTER SUJATHA K.K., DATED 07.04.2015. ANNEXURE A4 TRUE COPY OF THE DISABILITY CERTIFICATE ISSUED TO THE APPLICANT BY THE MEDICAL BOARD OF GOVERNMENT MEDICAL COLLEGE, THRISSUR, DATED 07.04.2015 ANNEXURE A5 TRUE COPY OF THE CERTIFICATE ISSUED BY DR.SURENDRA U. KAMATH, CONSULTANT ORTHOPAEDIC, K.M.C. HOSPITAL, MANGALORE TO THE APPLICANT, DATED 08.06.2019. ANNEXURE A7 TRUE COPY OF THE ORDER OF THIS HON’BLE TRIBUNAL IN O.A.(EKM) NO.512/2017 DATED 31.10.2017. ANNEXURE A8 TRUE COPY OF THE OFFICE MEMORANDUM DATED 31.05.2007 ISSUED BY MINISTRY OF HEALTH AND FAMILY WELFARE, GOVERNMENT OF INDIA. OP (CAT) NO. 46 OF 2024 -17- 2025:KER:27446 ANNEXURE A9 TRUE COPY OF THE ORDER OF THIS HON’BLE TRIBUNAL IN O.A.NO.469/2014 DATED 16.10.2015. ANNEXURE A10 TRUE COPY OF THE JUDGMENT OF THE HON’BLE HIGH COURT OF DELHI IN L.P.A.NO. 764/2017 DATED 01.12.2017. ANNEXURE R1 TRUE COPY OF THE OM NO.S-11012/2/2016- CGHS-P) DATED 08.11.2016. EXHIBIT -P1 TRUE COPY OF THE O.A.NO.180/00448/2020 BEFORE THE CENTRAL ADMINISTRATIVE TRIBUNAL, ERNAKULAM BENCH. EXHIBIT P2 TRUE COPY OF THE REPLY STATEMENT IN EXT.P1 FILED BY THE RESPONDENTS. EXHIBIT P3 TRUE COPY OF THE REJOINDER FILED BY THE PETITIONER TO EXT.P2. EXHIBIT P4 TRUE COPY OF THE ORDER DATED 25.01.2024 IN O.A.NO.180/00448/2020 OF THE CENTRAL ADMINISTRATIVE TRIBUNAL, ERNAKULAM BENCH. EXHIBIT P5 TRUE COPY OF THE MEDICAL CERTIFICATE DATED 21.02.2024 ISSUED BY DR.POULOSE GEORGE, M.D., CONSULTANT PHYSICIAN, THRISSUR DISTRICT CO-OPERATIVE HOSPITAL. EXHIBIT P6 TRUE COPY OF THE DISCHARGE SUMMARY IN RESPECT OF THE PETITIONER’S FATHER, ISSUED ON 20.11.2009 BY DR.DEVAPRASAD S. & DR.DAWN ANTONY, CONSULTANT, NEURO SURGEONS, ASWINI HOSPITAL PVT. LTD., THRISSUR. EXHIBIT P7 TRUE COPY OF THE CASH SALES BILL DATED 13.02.2024 ISSUED BY ROUND SOUTH SEVANA MEDICINES, THRISSUR, TO THE PETITIONER’S FATHER. OP (CAT) NO. 46 OF 2024 -18- 2025:KER:27446 EXHIBIT P8 TRUE COPY OF THE OF CASH SALES BILL DATED 15.11.2023 ISSUED BY ROUND SOUTH SEVANA MEDICINES, THRISSUR, TO THE PETITIONER’S FATHER. EXHIBIT P9 TRUE COPY OF THE CASH SALES BILL DATED 04.01.2024 ISSUED BY ROUND SOUTH SEVANA MEDICINES, THRISSUR, TO THE PETITIONER’S FATHER. EXHIBIT P10 TRUE COPY OF THE FRONT PAGE OF THE RATION CARD IS ISSUED IN FAVOUR OF THE PETITIONER’S UNMARRIED SISTER SMT.SUJATHA K.K. EXHIBIT P11 TRUE COPY OF THE DISCHARGE SUMMARY DATED 15.06.2023 IN RESPECT OF SMT.SUJATHA K.K., ISSUED BY KMC HOSPITAL, MANGALURU. EXHIBIT P12 TRUE COPY OF THE FINAL BILL DATED 15.06.2023 ISSUED BY KMC HOSPITAL, MANGALURU.