The liability period of the insurance company for medical reimbursement starts from the date of receiving the premium, and the disparity between rates prescribed in private hospitals and Medical Attendance Rules must be considered in determining entitlement for reimbursement.

JUDGMENT

(Prayer: Writ Petition filed under Article 226 of the Constitution of India for issuance of Writ of Mandamus, to direct the 2nd respondent to provide the medical claim by way of medical reimbursement a sum of Rs.2,01,436/- along with the interest at the rate of 12% per annum.)

1. This Writ Petition is filed for issuance of a Writ of Mandamus, to direct the 2nd respondent to provide the medical reimbursement a sum of Rs.2,01,436/- along with the interest at the rate of 12% per annum.

2. The brief facts of the case are that the petitioner had worked as Inspector of Police in Theppakulam Police Station in Madurai city. The petitioner was placed under suspension in connection with a case in Crime No.9/2007 on 06.09.2007. The petitioner attained superannuation on 31.07.2008 and he was not allowed to retire due to the pendency of the aforesaid criminal case till now. The petitioner is under suspension and salary is paid without exceeding the provisional pension. The petitioner comes under the New Health Insurance Schemes for retired employees, since 2014. The petitioner suffered health disorder during September, 2014 and was admitted as inpatient at Vadamalayan Hospital Private Limited in Madurai. The petitioner has undergone by-pass grafting in the "Off Pump Coronary Artery". In pursuance of the surgery, the petitioner was under medical care. The said ailment is included in the list of ailments. The petitioner applied for reimbursement for the said medical expenses. Since the same was not considered, the petitioner preferred a writ petition in W.P. (MD)No.10193 of 2015 for the reimbursement of my medical expenses. This Court, vide order, dated 15.07.2015, has as follows:

"When the matter is taken up for hearing it is represented by the learned Additional Government Pleader that the Government has now recovered the contribution for availing the medical benefit/medical claim under the new health insurance scheme from the petitioner.

The submission made by the learned Additional Government Pleader is recorded. In view of the above, the respondents are directed to extend the medical benefits to the petitioner immediately.

With the above direction, this writ petition stands disposed of. No costs.”

3. Since the petitioner was under suspension, the contribution was not taken from the petitioner salary. Subsequently, the contribution was taken and the same was recorded. In spite of the same, since the amount was not paid and the order was not complied, the petitioner preferred Cont.P.(MD)No.449/2017. Since the writ petition was heard without hearing the Insurance Company, the contempt petition was closed.

4. The contention of the petitioner is since 2014, the contribution is collected from the petitioner. The second respondent Insurance Company is liable to reimburse the said amount. During the pendency of the contempt petition, the Government has granted a sum of Rs.52,545/- as part of the medical reimbursement, but the remaining amount a sum of Rs.2,01,436/- has to be paid.

5. The petitioner is 67 years old and living with a subsidence allowance alone. The 2nd respondent is liable to reimburse the entire claim. Hence, the petitioner has filed this writ petition seeking the balance amount.

6. In the counter affidavit it is stated that the first respondent Commissioner of Police has stated that the claim in the writ petition is against the Insurance Company and the Commissioner of Police is an unnecessary part and has prayed to delete his name. The third respondent namely, the Director of Treasuries and Accounts, Chennai was impleaded as third respondent, vide order, dated 24.11.2021.

7. The second respondent has denied that they are not liable to pay the amount even though the contribution is collected from the petitioner for medical insurance because, any subsequent collection is not binding the insurance company. The insurance company is liable from the date of payment of premium and the medical claim ought to be after premium