RTI for Medical Reimbursement

RTI for a Delayed Medical Reimbursement Claim

Medical reimbursement claims — CGHS, ECHS, ESIC, serving government-employee, PSU and state-department medical bills, and pensioner or family claims — often sit for months with no clear reason. An RTI makes the office state on record where your claim file is, who is holding it, and why — usually enough to move a stalled bill.

Who to file the RTI to

• CGHS: the CPIO/PIO of the CGHS office handling your claim, such as the Wellness Centre / Additional Director / city CGHS office, depending on where the file is processed.
• ECHS: the CPIO/PIO of the ECHS office handling the claim, such as the Polyclinic, Regional Centre or controlling Station HQ, depending on the claim route.
• ESIC: the CPIO/PIO of the ESIC Branch, Regional Office or hospital/dispensary office handling the claim.
• Serving government employees: the PIO of your department’s DDO / accounts / establishment section that processes the reimbursement.
• PSU or state-health cases: the PIO of the PSU’s HR/medical cell or the State Health Department, depending on the scheme.

Try these official channels first

An RTI is the accountability step. First quote your claim/bill number and submission acknowledgement, follow up in writing with the accounts/medical section, and lodge a grievance on the department portal or on CPGRAMS (pgportal.gov.in) where available. Keep the grievance/reference number — quoting it in the RTI puts the delay on record. If those produce no movement, file the RTI.

What an RTI can ask for

• The current status and complete file movement of your reimbursement claim.
• The name and designation of the officer/desk currently holding the claim.
• The reasons recorded for any objection or delay.
• A certified copy of any deficiency memo or query raised on the claim.
• The bill-processing status and the amount admitted/disallowed, with the reasons recorded.
• Any recorded expected disposal date or timeline, if available on record.

Copy-paste RTI application

To,
The Public Information Officer,
[CGHS / ECHS / ESIC office OR your department's DDO / Accounts Section],
[City]

Subject: Request for information under the Right to Information Act, 2005

Sir/Madam,

Under Section 6 of the Right to Information Act, 2005, I request the following information regarding my medical reimbursement claim:

1. The current status and complete file movement of my medical reimbursement claim no. ________ dated ________, for bills submitted on ________.
2. The name and designation of the officer/desk with whom the claim is currently pending, and the number of days pending at each stage.
3. The reasons recorded for any objection, deficiency or delay, with a certified copy of any deficiency memo or query issued on the claim.
4. The bill-processing and sanction status, and the amount admitted/disallowed with the reasons recorded.
5. Any recorded expected disposal date or timeline for the claim, if available on record.
6. The action taken on my grievance/representation no. ________ dated ________, if any.

I am enclosing the RTI application fee as prescribed for this public authority by Indian Postal Order / court-fee stamp / online payment proof / other accepted mode. [If you hold a BPL card: a copy is enclosed and no application fee is payable.] Please provide the information within 30 days as required under Section 7(1) of the RTI Act, 2005.

Place: ____________     Date: ____________

[Your Full Name]
[Full Postal Address]
[Phone / Email]

Read more: RTI for pending medical reimbursement of government employees. Not sure which office holds your file? Use FindMyPIO, or let FileMyRTI draft and file it for you.