Mohan.S.R v. The Director Of Pensions
BEFORE THE MADURAI BENCH OF MADRAS HIGH COURT DATED: 15.11.2023
CORAM
THE HON'BLE MR.JUSTICE R.VIJAYAKUMAR S.R.Mohan ... Petitioner Vs.
1.The Director of Pensions, Perasiriyar K.Anbazhagan Maaligai, 3rd Floor, 571, Anna Salai, Nandanam, Chennai-35.
2.The Commissioner of Treasuries and Accounts, Perasiriyar K.Anbazhagan Maaligai, 3rd Floor, 571, Anna Salai, Nandanam, Chennai-35.
3.The District Collector, 4.The District Coordinator, Indian Health Insurance Private Ltd., No.1/5, Durai Raj Chathira Street, Velipattinam Post, Ramanathapuram-623 504.
5.The Joint Director of Medical and Rural Health Services, Kenikkarai, Ramanathapuram District.
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6.The District Treasury Officer, 7.The Managing Director, United India Insurance Company Ltd., Head Office, No.19, Nungambakkam High Road, 4th Lane, Chennai-34.
8.MD India Health Insurance TPA Pvt. Ltd., Raheja Towers, Unit # 005, Delta Wing # 177, Ground Floor, Mount Road, Anna Salai, Chennai-600 002.
... Respondents PRAYER : Writ Petition filed under Article 226 of the Constitution of India, praying this Court to issue a Writ of Mandamus, directing the 7th respondent to reimburse a sum of Rs.2,03,617/- to the petitioner under Government of Tamil Nadu New Health Insurance Scheme, 2022 towards the medical expenses incurred by the petitioner by considering the representation of the petitioner, dated 07.09.2023. For Petitioner : Mr.A.K.Baskarapandiyan For R1- R3,R5,R6 : Mr.J.Ashok Additional Government Pleader For R7 : Mr.I.Suthakaran Standing Counsel For R8 : No Appearance 2/7
ORDER
The present writ petition has been filed by a retired Assistant Treasury Officer seeking a Mandamus to direct the 7th respondent Insurance Company to disburse the reimbursement of medical expenses incurred by the writ petitioner.
2. According to the learned counsel appearing for the writ petitioner, the petitioner attained superannuation on 31.01.2006 and he is a member of New Health Insurance Scheme (NHIS), 2022. Due to heart ailment, the petitioner was admitted at Natraj Cardiac Care, Ramanathapuram on 28.10.2022 and after undergoing Angioplasty procedure, he was discharged form the hospital on 31.10.2022. The petitioner has further contended that he had incurred a sum of Rs. 3,08,617/- (Rupees Three Lakh Eight Thousand Six Hundred and Seventeen only) as medical expenses. The petitioner had applied for reimbursement of the medical expenses to the 7th respondent Insurance Company.
3. The 7th respondent Insurance Company without assigning any reasons, had cleared the reimbursement only to an extent of Rs. 3/7
1,05,000/- (Rupees One Lakh and Five Thousand only). Since the balance amount was not reimbursed, the petitioner had approached the 3rd respondent. The 3rd respondent by his proceedings, dated 18.04.2023, has forwarded the said request of the writ petitioner to various authorities, including the 5th respondent herein.
4. A perusal of G.O.Ms.No.204 Finance (Health Insurance) Department, dated 30.06.2022 reveals that in case of any grievance of a claimant relating to the reimbursement of payment made to a network hospital, they have to approach the grievance redressel officer to verify the claims. In the present case, the 5th respondent is the grievance redressal officer of the concerned district. The representation forwarded by the 3rd respondent herein on 18.04.2023 is still pending before the 5th respondent herein.
5. In view of the above said facts, the 5th respondent is directed to consider the said letter forwarded by the 3rd respondent on 18.04.2023 along with the medical bills submitted by the writ petitioner in the light of G.O.Ms.No.204 Finance (Health Insurance) Department, dated 30.06.2022 and pass orders within a period of four (4) weeks from the 4/7
date of receipt of copy of this order. In case, if the petitioner has not submitted his bills, the same may be submitted directly to the 5th respondent herein within a period of one week from the date of receipt of copy of this order.
6. With the said observations, this Writ petition stands disposed of. No costs.
15.11.2023 NCC :
Yes / No Index :
Yes / No Internet :
Yes / No gbg To 1.The Director of Pensions, Perasiriyar K.Anbazhagan Maaligai, 3rd Floor, 571, Anna Salai, Nandanam, Chennai-35.
2.The Commissioner of Treasuries and Accounts, Perasiriyar K.Anbazhagan Maaligai, 3rd Floor, 571, Anna Salai, Nandanam, Chennai-35.
3.The District Collector, 5/7
4.The Joint Director of Medical and Rural Health Services, Kenikkarai, Ramanathapuram District.
5.The District Treasury Officer, 6/7
R.
VIJAYAKUMAR ,J.
gbg Order made in Dated:
15.11.2023 7/7