The treatment in a non-network hospital cannot exclude medical reimbursement from being rejected.
Title- C. Mani VS Principal Secretary to Government of Tamil Nadu and others.
Court- The High Court of Madras
Case No. – W.P. (MD) No. 25304 of 2018
Decided on- 5th December, 2023.
Coram- Before Mr. S.M. Subramaniam and Mr. V. Lakshminarayanan, JJ
Introduction- The order of rejection to settle the medical reimbursement claim of the writ petitioner issued by the Director of Health and Rural Services is under challenge in this writ petition.
Facts- The petitioner is a State pensioner and a member of Medical Health Scheme. The petitioner was Chief Administrative Officer in Principal District Court, Pudukkottai and retired from service on 30.09.2010. He was paying subscription under the scheme regularly. The petitioner spent sum of Rs. 1,24,576/- as medical expenses. He submitted application for medical reimbursement and it was rejected by the Director of Health and Rural Services on the ground that the petitioner undertook treatment in a non-network hospital and therefore, the petitioner is not eligible for medical reimbursement claim. Aggrieved by this the Petitioner filed this petition.
Issues- Whether medical reimbursement can be rejected on the ground of non-network hospital?
The Court said that the issues regarding the settlement of the medical claim are no more res-integra in respect of the treatment undertaken in a non- network hospital. Several Court orders have been passed to settle the medical reimbursement claim and not to reject the same merely on the ground that the hospital is not falling under the list of network hospitals.
Court Analysis and Decision- In the present case, the genuinity of the treatment taken by the petitioner has not been disputed. The court said that once the treatment is found to be genuine, there is no reason to reject the medical claim of the petitioner.
After considering the facts and circumstances, the court set aside the impugned order passed by the Director of Health and Rural Services (2nd Respondent) dated on 2nd April, 2018. The court directed the Divisional Manager of United India Insurance Company Limited (7th Respondent) to settle the eligible medical reimbursement claim of the petitioner under the scheme within the period of six weeks from the date of receipt of a copy the court order. The court allowed this writ petition.
Insight- What is medical reimbursement?
Medical reimbursement is an arrangement between an employer and employee where the employer reimburses a portion of the employee’s medical expenses. It is a fixed amount provided by the employer to the employee to meet medical expenses.
WRITTEN BY:Nireesha rao
🏥💼 Important ruling! The High Court of Madras emphasizes that medical reimbursement cannot be denied solely based on treatment in a non-network hospital. Another victory for genuine medical claims! #LegalInsights #HealthcareRights 📝⚖️
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