G.Sankaranarayanan v. The Principal Secretary / Commissioner Of
BEFORE THE MADURAI BENCH OF MADRAS HIGH COURT DATED : 15.11.2023
CORAM:
THE HONOURABLE MR.JUSTICE R.VIJAYAKUMAR W.P(MD)No.25240 of 2023 G.Sankaranarayanan ... Petitioner Vs.
1. The Principal Secretary/ Commissioner of Treasuries and Accounts, New Health Insurance Scheme 2014, Integrated Office Complex for Finance Department, Nandanam, Chennai.
2. M/s. The United India Insurance Company Limited, Represented by its Divisional Manager, 212, PLA Rathna Towers, 5th Floor, Anna Salai, Chennai - 600 006.
... Respondents PRAYER: Writ Petition filed under Article 226 of the Constitution of India, praying this Court to issue a Writ of Mandamus, directing the second respondent to reimburse the medical expenses of Rs.7,33,509.32/- (Rupees Seven Lakhs Thirty Three Thousand Five Hundred and Nine and Paise Thirty Two only) with interest to the petitioner under the Health Insurance Scheme within the time frame fixed by this Court.
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For Petitioner : Mr.S.Suresh Manickam For Respondents : Mr.R.Suresh Kumar Additional Government Pleader For -R1 : Mr.I Suthakaran Standing Counsel - for R2
O R D E R
The present writ petition has been filed by a retired Government servant seeking a mandamus as against the Government and the Insurance Company for reimbursement of the Medical expenses with interest under the Health Insurance Scheme.
2. According the writ petitioner, he has undergone a bypass surgery in Kerala Institute of Medical Science Hospital (KIMS) at Thiruvananthapuram, Kerala State, wherein, he has incurred expenses to a tune of Rs.7,33,509.32/- (Rupees Seven Lakhs Thirty Three Thousand Five Hundred and Nine and Paise Thirty Two only) and enclosing the medical bills, he has addressed a communication to the second respondent/Insurance Company making a claim for reimbursement. The second respondent/Insurance Company has reimbursed only to an extent of Rs.3,17,812/- (Rupees Three Lakhs Seventeen Thousand Eight Hundred and Twelve only) without assigning any 2/5
reasons whatsoever for not paying the balance amount. Aggrieved over the said act of the second respondent, the present writ petition has been filed.
3. Pending writ petition, the second respondent/Insurance Company has addressed a communication to the writ petitioner to the effect that as per the agreed package, the entire amount has been disbursed to them. Without assigning any reasons, the balance amount has been rejected. Therefore, it is clear that there is a dispute between the Insurance Company and the claimant with regard to the quantum of reimbursement to be made to the writ petitioner.
4. In view of G.O(Ms)No.204, Finance Department, dated 30.06.2022, the petitioner has to approach the Grievance Redressal Officer with regard to the rejection of portion of his claim. Therefore, the petitioner herein is directed to approach the Grievance Redressal Officer, Tirunelveli District, namely, the Joint Director of Medical and Rural Health Services, Tirunelveli within a period of two weeks from the date of receipt of a copy of this order. On such receipt, the Grievance Redressal Officer is directed to dispose of the said grievance within a period of four weeks thereafter. 3/5
5. With the above said observations, this Writ Petition stands disposed of. There shall be no order as to costs.
15.11.2023 NCC : Yes/No Index : Yes / No Internet : Yes / No ebsi To The Principal Secretary/ Commissioner of Treasuries and Accounts, New Health Insurance Scheme 2014, Integrated Office Complex for Finance Department, Nandanam, Chennai.
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R.VIJAYAKUMAR,J.
ebsi W.P(MD)No.25240 of 2023 15.11.2023 5/5