S. Paranthaman v. United India Insurance Co. Ltd
IN THE HIGH COURT OF JUDICATURE AT MADRAS
DATED: 04-07-2025
CORAM
THE HONOURABLE MR.JUSTICE C.KUMARAPPAN
1. S. Paranthaman S/o.Shri. Sivaramakrishna Petitioner(s) Vs
1. United India Insurance Co. Ltd Rep. By Its General Manager, LBO: 010600, Silingi Buildings, 34, Greems Road, Chennai - 600006.
2.The Director Directorate Of Social Defense, Juvenile Justice Board And Government Observation Home Purasaiwakkam, Chennai - 600010.
Respondent(s) PRAYER To call for the records in Ref No.010600/CRS-459/14/2024 dated 27.01.2025 on the file of the 1 st respondent and quash the same and consequently, direct the 1 st respondent to reimburse the sum of Rs.1,41,666/- spent by the petitioner herein with reasonable interest awarded.
For Petitioner(s):
Mr. B. Manoharan For Respondent(s):
Mr.P. Athi Veera Rama Pandian, for R1 Mr.N.Naveen Kumar Government Advocate for R2
ORDER
The instant writ petition has been filed challenging the impugned order dated 07.01.2025, wherein the petitioner's claim for reimbursement of a sum of Rs.1,41,666/- being the amount spent for treatment for the period between 25.10.2024 and 31.10.2024 was rejected on the ground that the diagnosis and line of management are not covered by the Government orders.
2. At this juncture, the learned counsel for the petitioner would submit that in the judgment of this Court in the case of S.Marimuthu Vs. The Government of Tamil Nadu, in WP.(MD).No.13429 of 2013 and batch, this Court, after elaborately considering various aspects, has observed in Paragraph No.80 as follows:
"80. In order to reconsider all these claim made by the respective writ petitioners for medical reimbursement, by remitting the matters back, the following directions are issued:
(i) All the impugned orders in the respective writ petitions in this batch of cases, are hereby quashed.
(ii) The writ petitions where impugned orders
are quashed as well as the writ petitions where mandamus sought for, are hereby remanded with directions to the concerned District Level Empowered Committee, before whom, these matters shall be placed and the Committee shall reconsider every individual case.
(iii) While reconsidering, the Committee shall not reject any claim merely on the reason of non network hospital or non listed disease.
(iv) The Committee, wherever possible, shall give suitable direction to the Insurance Company to reimburse the claim made by the respective claimant / employee / pensioner.
(v) If the Committee finds some cases where the Insurance Company cannot be directed to reimburse, in those cases, suitable orders shall be passed directing / recommending the State authorities to reimburse the claim under Medical Attendance Rules. (vi) Once such orders are passed, the Insurance Company shall immediately reimburse the medical claim with 6% interest from the date of due till date of payment, within a period of thirty days from the date of receipt of such order to be passed by the Empowered Committee of the District concerned."
3. Even while looking at the impugned order, it is mentioned that if there is any grievance in respect of the impugned order, they have a right to appeal before the District Level Empowerment Committee. Therefore, by following the
above judgment, this Court deems it appropriate to direct the petitioner to approach the District Level Empowerment Committee within a period of two weeks from the date of receipt of a copy of this order. If any appeal has been filed by the petitioner within that period, the District Level Empowerment Committee is directed to dispose of the same within a further period of four weeks, according to its own merits and in accordance with law.
4. With the above directions, the writ petition is disposed of. No costs. Consequently, the connected miscellaneous petitions, if any, are closed. 04-07-2025 gd Index:Yes/No Speaking/Non-speaking order Internet:Yes
To 1.United India Insurance Co. Ltd Rep. By Its General Manager, Lbo.
010600, Silingi Buildings, 34, Greems Road, Chennai - 600006.
2.The Director Directorate Of Social Defense, Juvenile Justice Board And Government Observation Home Purasaiwakkam, Chennai - 600010.
C.KUMARAPPAN J.
gd 04-07-2025