Back
BEFORE THE MADURAI BENCH OF MADRAS HIGH COURT
HONOURABLE MR. JUSTICE B.PUGALENDHI
T. Jeyarani – Appellant
Versus
Principal Secretary/Commissioner of Treasuries and Accounts – Respondent
ORDER :
1. The petitioner is the wife of one Mariya Pakthan, who is a retired Craft Instructor from Subbiah Vidyalayam Middle School, Devarpuram Road, Tuticorin. He has retired from service on 01.07.2020. He was a member of the New Health Insurance Scheme 2018, for pensioners. On 08.01.2018 at 12.20 a.m, the petitioner's husband was suffering with severe abdominal pain. Therefore, the petitioner has taken him to the nearest hospital, namely, Sacred Heart Hospital, Tuticorin, wherein, he was diagnosed with ''Appendicular perforation with terminal ileal''. In order to avoid further complications, he underwent appendicectomy surgery through Laparoscopy. While he was in IMCU, he died due to cardiac arrest on 25.01.2018. A sum of Rs.2,42,385/- has been incurred by the petitioner towards her husband's medical treatment. Therefore, the petitioner has submitted an application on 28.02.2018 to the third respondent along with the medical records, for reimbursement of the amount spent by her for her husband's medical treatment. The third respondent has rejected the claim of the petitioner that the treatment has been taken in a non-network hospital and therefore, she is not entitled for medical
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 situations, patients are not required to seek treatment only in a network hospital for medical reimbursement, as established by settled law.
Medical reimbursement claims cannot be denied based on treatment at non-network hospitals, especially in emergencies, as necessity of treatment is paramount.
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.
In emergency medical situations, full reimbursement of medical expenses is mandated regardless of any imposed ceiling limits, emphasizing the right to timely medical treatment.
Dependents of deceased government employees are entitled to reimbursement of medical expenses incurred, regardless of insurance coverage withdrawal due to death before surgery.
Emergency medical treatments require reimbursement even if provided by non-empanelled facilities, prioritizing the necessity of treatment over technical compliance with prescribed rates.
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.
An indispensable Tool for Legal Professionals, Endorsed by Various High Court and Judicial Officers
Please visit our Training & Support
Center or Contact Us for assistance
Scan Me!
India’s Legal research and Law Firm App, Download now!
For Daily Legal Updates, Join us on :
Back to top
