Kaliappan R v. The Government Of Tamil Nadu
1 W.P.(MD)NO.8725 OF 2023 BEFORE THE MADURAI BENCH OF MADRAS HIGH COURT DATED: 27.06.2023
CORAM
THE HONOURABLE MR.JUSTICE G.R.SWAMINATHAN W.P.(MD)No.8725 of 2023 R.Kaliappan ... Petitioner Vs.
1. The Government of Tamil Nadu, Rep. by its Secretary, Finance (Pension) Department, Fort St. George, Chennai - 600 009.
2. The Director of Treasuries and Accounts, Panagal Building, Saidapet, Chennai - 600 015.
3. The District Collector/ Chairman, District Level Empowered Committee, Madurai District, Madurai - 625 020.
4. The Joint Director of Medical and Rural Health Services-cum-Member of District level Empowered Committee, Government Hospital, Usilampatti, Madurai District.
5. The District Treasury Officer, District Treasury, Madurai - 625 020.
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2 W.P.(MD)NO.8725 OF 2023
6. M/s.United India Insurance Co. Ltd., Divisional Office-VI, rep. by its Divisional Manager, PLA Rathina Towers 5th Floor, 212, Anna Salai, Chennai - 600 006.
7. S.Vasudevan Iyengar, Public Information Officer, United India Insurance Co.Ltd., 134, Silingi Buildings, Greams Road-R.O., Chennai - 600 006.
... Respondents Prayer: Writ petition is filed under Article 226 of the Constitution of India, to issue a Writ of Mandamus, directing the 1st to 5th respondents to reimburse the petitioner's medical expenses of Rs. 5,32,000/- vide Bill No.17659 dated 23.02.2022 of Vadamalayan Hospitals (P) Ltd., Madurai-2 or eligible amount as per rules in force, for the petitioner's medical treatment underwent from 08.02.2022 to 23.02.2022 at Vadamalayan Hospital Private Limited, Madurai, within a time limit to be fixed by this Court.
For Petitioner : Mr.A.Thirumurthy For R-1 to R-5 : Mr.K.Balasubramani, Special Government Pleader.
For R-6 & R-7 : Mr.A.Shajahan, Standing Counsel.
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3 W.P.(MD)NO.8725 OF 2023
O R D E R
Heard the learned counsel on either side.
2. The petitioner is a retired Government employee. He is a member of the New Health Insurance Scheme. He had taken treatment in a network hospital. However, he incurred a sum of Rs.5,32,000/-. The petitioner claims reimbursement. The District Level Empowered Committee had recommended that the petitioner's claim should be honoured by the insurer.
3. It has been held by a learned Judge of this Court that if the District Level Empowered Committee had recommended the proposal, the insurer has only two options; he must the honour the claim or he must file an appeal before the State Level Committee. In this case, without filing such an appeal, the insurer had chosen to reject the claim straightaway. Vide communication dated 14.02.2023, the stand of the sixth respondent is that this line of treatment is not covered.
4. I do not understand as to how the sixth respondent could have 3/6
4 W.P.(MD)NO.8725 OF 2023 taken such stand though the recommendation was made by the District Level Empowered Committee. The second respondent will hear the petitioner and the sixth respondent and shall dispose of the petitioner's claim. An order on merits and in accordance with law will be passed by the second respondent within a period of ten weeks from the date of receipt of a copy of this order. This writ petition stands disposed of. No costs.
27.06.2023 NCS : Yes / No Index : Yes / No Internet : Yes / No PMU 4/6
5 W.P.(MD)NO.8725 OF 2023 To:
1. The Government of Tamil Nadu, Rep. by its Secretary, Finance (Pension) Department, Fort St. George, Chennai - 600 009.
2. The Director of Treasuries and Accounts, Panagal Building, Saidapet, Chennai - 600 015.
3. The District Collector/ Chairman, District Level Empowered Committee, Madurai District, Madurai - 625 020.
4. The Joint Director of Medical and Rural Health Services-cum-Member of District level Empowered Committee, Government Hospital, Usilampatti, Madurai District.
5. The District Treasury Officer, District Treasury, Madurai - 625 020.
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6 W.P.(MD)NO.8725 OF 2023 G.R.SWAMINATHAN,J.
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