Court rules urgent life-saving treatment cannot be denied reimbursement solely due to hospital's non-empanelled status under FCI Post-Retirement Medical Scheme
In a landmark judgment dated 24th September 2026, the Kerala High Court (Division Bench) delivered a significant verdict in the case of Food Corporation of India (FCI) versus Govindan P., addressing the issue of medical reimbursement under the FCI Post-Retirement Medical Scheme (PRMS). The case arose when the respondent, a retired FCI employee diagnosed with malignant papillary urothelial carcinoma, underwent urgent life-saving surgery at Aster Medicity Hospital, which was not empanelled under the Central Government Health Scheme (CGHS) - a prerequisite for reimbursement under PRMS.
The FCI had rejected Govindan's claim for reimbursement of Rs. 3,64,126 solely on the ground that the surgery was performed at a non-CGHS empanelled hospital. The respondent challenged this denial before the Kerala High Court Single Judge, who ruled in his favor, a decision now upheld by the Division Bench.
Counsel for FCI contended that the PRMS clearly mandated treatment at empanelled hospitals, including government or nationally reputed hospitals approved by the FCI's CMD. They argued that the surgery was elective, not emergent, as the respondent's correspondence indicated he initially sought treatment at an empanelled hospital (Amrita Hospital, Kochi) but shifted to Aster due to apprehended delay.
However, the Court emphasized the gravity and urgency of the respondent's life-threatening disease. It underscored that when it comes to serious illnesses requiring life-saving treatment, the patient's choice of hospital and treatment protocol takes precedence over rigid technicalities such as empanelment status. The judgment referred extensively to the Supreme Court ruling in Shiva Kant Jha v. Union of India [(2018) 16 SCC 187], which affirmed that patients cannot be compelled to verify hospital empanelment amid medical emergencies.
Further, the Court observed that seeking a second opinion or opting for faster treatment in a grave cancer case is normal human conduct and does not negate the urgency of surgery. The Division Bench also noted a similar precedent set by the same Court in Union of India v. K.J.Joseph [2026 KERHC 532], where reimbursement was granted under analogous facts.
The judgment clarified that the relief granted is confined to the peculiar facts of the case and cautioned against applying a standardized formula in medical reimbursement claims involving serious illnesses.
This ruling sets an important precedent affirming that the technicality of hospital empanelment cannot be allowed to override the urgent medical needs of retired employees under government health schemes.
Bottom Line:
Medical reimbursement - Post-Retirement Medical Scheme - Reimbursement cannot be denied solely on the ground that life-saving cancer surgery was undertaken in a non-CGHS empanelled hospital - In peculiar facts, urgency and gravity of disease, and treating requirements, outweigh technical objection regarding empanelment.
Statutory provision(s):
Food Corporation of India Post-Retirement Medical Scheme, Central Government Health Scheme (CGHS).
Food Corporation of India v. Govindan P., (Kerala)(DB) : Law Finder Doc Id # 3000625
