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IN THE HIGH COURT OF JUDICATURE AT MADRAS
C.SARAVANAN, J
G. Bhanumathi – Appellant
Versus
Principal Secretary, Labour and Employment (OP-2-1) Department – Respondent
ORDER :
(C. SARAVANAN, J.)
In the present writ petition, the petitioner has challenged the G.O.(Rt.)No.384, Labour and Employment (OP2-1) Department dated 31.12.2013 passed by the 1st respondent. By the impugned order, the claim of the petitioner for reimbursement of medical expenses incurred for the treatment of her husband (deceased) has been rejected.
2. The brief facts of the case are that the petitioner's husband G.Bhagirath was working as an Under Secretary to Government in the 1st respondent Department. Due to chest pain, he was admitted at Sri Ramachandra Medical Centre, Porur for treatment on 03.07.2009 where angiogram was performed on him which revealed the blocks in his blood vessels. Hence, he was advised stent operation and Bye-Pass surgery.
3. Thus, stent operation was performed on the petitioner's husband on 03.07.2009 and he was therefore kept under observation in ICU prior to the Bye-Pass surgery. However, even before the Bye-Pass surgery could be performed, the petitioner's husband died on 04.07.2009. Thereafter, the Hospital authorities informed the petitioner that the Insurance Coverage is withdrawn as her husband had died even before the Bye-Pass surgery.
4. Hence,
Dependents of deceased government employees are entitled to reimbursement of medical expenses incurred, regardless of insurance coverage withdrawal due to death before surgery.
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.
Medical reimbursement claims cannot be denied based on treatment at non-network hospitals, especially in emergencies, as necessity of treatment is paramount.
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.
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 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 Atte....
The right to medical aid is fundamental under Article 21, and reimbursement for treatment at private hospitals during emergencies cannot be denied, upholding the principles of fairness and timely adm....
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