LAWS(MAD)-2019-4-574

P.SANKARAN Vs. STATE OF TAMIL NADU

Decided On April 12, 2019
P.SANKARAN Appellant
V/S
STATE OF TAMIL NADU Respondents

JUDGEMENT

(1.) The relief sought for in the present writ petition is to quash the order Na.Ka. 16053/2016/No.1 dated 14.11.2016 rejecting the claim of the writ petitioner for medical reimbursement.

(2.) The learned counsel for the writ petitioner states that the petitioner served in the Tamil Nadu Police Department and retired from service on 31.01.2000 on attaining the age of superannuation. The writ petitioner is a member of the New Health Insurance Scheme and the monthly premiums are deducted / recovered from the monthly pension of the writ petitioner without any default. Accordingly, he is eligible for medical reimbursement for the treatment undergone.

(3.) The writ petitioner had undergone a surgery in a hospital which is not listed in the Government orders. In view of the fact that the treatment was taken in an unapproved hospital, the fifth respondent United India Insurance Company rejected the claim of the writ petitioner to reimburse the medical claim of the writ petitioner. Along with the bills and the discharge summary, the petitioner submitted an application, seeking Medical Reimbursement as he is the member of the Medical Reimbursement Scheme. The United India Insurance Company Limited, rejected the claim on the ground that the Hospital, in which, the writ petitioner had taken treatment, is not a listed hospital and therefore, as per the terms and conditions of the Medical scheme, the writ petitioner is not entitled for Medical Reimbursement. In this regard, in respect of the cases, where the treatment is taken in an unapproved hospitals, this Court passed orders in W.P.No.26508 of 2017 dated 09.10.2018 and the relevant paragraphs 8 and 9 are extracted hereunder:-