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IN THE HIGH COURT OF JUDICATURE AT MADRAS
C.V. Karthikeyan, J
P. Duraisamy – Appellant
Versus
Collector, Salem – Respondent
ORDER :
1. The writ petition has been filed in the nature of a Certiorarified Mandamus calling for the records relating to the letter of rejection of claim in Ref.No.010600/CRS-51/1/2023, dated 21.09.2023, on the file of the 5th respondent and quash the same. Petitioner seeks reimbursement of the medical expenses of Rs.85,114/- incurred by the petitioner for the medical treatment of his wife at G. Kuppusamy Naidu Hospital, Coimbatore.
2. This Court had heard both the learned counsel for the petitioner and the learned counsel for the respondents and had passed the following order on 12.02.2025.
1. This writ petition has been filed for issuance of a writ of certiorarified mandamus calling for records relating to the letter of rejection of claim in Ref:010600/CRS-51/1/2023 dated 21.09.2023 on the file of the 5th respondent and quash the same and direct the respondents to reimburse the medical expenses of Rs.85,114/- incurred by the petitioner for the medical treatment of his wife at G. Kuppusamy Naidu Memorial Hospital, Coimbatore.
2. In the affidavit filed in support of the writ petition it had been stated by the petitioner, P.Duraisamy that he had retired as Head Master in Government El
In emergencies, patients cannot be expected to verify if a hospital is part of a network for insurance coverage, and claims must be assessed based on existing medical conditions.
Medical reimbursement claims cannot be denied based on treatment at non-network hospitals, especially in emergencies, as necessity of treatment is paramount.
In emergency situations, patients are not required to seek treatment only in a network hospital for medical reimbursement, as established by settled law.
The right to medical claim cannot be denied on technical grounds, and the factum of treatment should be the real test for honoring medical claims.
Legitimate medical claims cannot be denied on technical grounds when emergency circumstances necessitate treatment; the focus must be on the fact of treatment supported by valid records.
Recommendations by District Level Empowered Committee regarding medical reimbursements are binding, and claims cannot be denied based on non-network treatment when such claims are legitimate.
In emergency medical situations, full reimbursement of medical expenses is mandated regardless of any imposed ceiling limits, emphasizing the right to timely medical treatment.
The obligation of the department to reimburse medical treatment in a private or unrecognized hospital as per the applicable Rules, despite technicalities of the Medi-claim policy.
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