G.ANTHONY Vs. UNITED INDIA INSURANCE COMPANY LIMITED

JUDGEMENT

(1.) Heard Mr. J.Muthukumaran, Learned Counsel for the Petitioner, Mr. P.Sankaranarayanan, Learned Counsel for the First Respondent and Mr. S.Balamurugan, Learned Government Advocate appearing for the Third to Fifth Respondents and perused the materials placed on record apart from the pleadings of the parties.

(2.) The Petitioner, who is receiving pension on retirement from service as teacher in Government School, has availed the benefits of the New Health Insurance Scheme for Pensioners of the Government of Tamil Nadu in G.O. Ms. No. 171, Finance (Pension) Department dtd. 26/6/2014 by making periodical contributions towards insurance premia from his pension. As the Petitioner suffered from severe stomach pain and vomiting on 18/6/2018, he was treated at Global Hospitals and Health City, Perumbakkam, Chennai and was diagnosed with stone formation in the urinal passage and was advised to immediately undergo surgery for the same. According to the Petitioner, in view of the urgency involved, the surgery was performed on the same day incurring medical expenses of Rs.1,22,879.00, which has been paid by him. When the Petitioner made a claim for reimbursement of the said medical expenses under the New Health Insurance Scheme, 2014, the Fifth Respondent by Letter in Na. Ka. No. 3564/2017/Aa1 dtd. 12/11/2018 informed him that the District Level Empowered Committee by proceedings dtd. 9/11/2018 had rejected the claim and that he may prefer an appeal before the State Level Empowered Committee in that regard. Inasmuch as the Fifth Respondent had neither furnished the copy of the proceedings dtd. 9/11/2018 of the District Level Empowered Committee nor had disclosed the reasons for rejection of the claim for medical reimbursement, the Petitioner has filed this Writ Petition challenging the said Letter in Na. Ka. No. 3564/2017/Aa1 dtd. 12/11/2018 issued by the Fifth Respondent and sought consequential direction for reimbursement of the medical expenses of Rs.1,22,879.00 to him within a time limit that may be fixed by the Court.

(3.) Though the Fifth Respondent has filed Counter-Affidavit dtd. 7/8/2019 and has reiterated that the Petitioner may prefer appeal before the State Level Empowered Committee, the reasons for rejection of the claim have not been explained.