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IN THE HIGH COURT OF JUDICATURE AT MADRAS
Battu Devanand, J
M. Joseph – Appellant
Versus
District Treasury Officer, District Treasury Office, Coimbatore – Respondent
ORDER :
Battu Devanand, J.
This Writ Petition has been filed to issue a Writ of Certiorarified Mandamus, to call for the records relating to the order passed by the first respondent in Na.Ka.No.703/2018/Ku 3 dated 16.02.2018 and signed on 16.03.2018 and quash the same thereby direct the respondents to pay a sum of Rs.71,683/- spent by the petitioner towards medical expenses with 18% interest from 02.02.2017 until the date of payment.
2. The case of the petitioner is that, he worked in the Government Department as Weaving Inspector and retired from service on 31.10.1988 and drawing pension from the first respondent. The Government of Tamil Nadu has entered into a contract with the United India Insurance Company in the name of Health Insurance Scheme from the year 2014 for the Government employees, pensioners and there family members. The petitioner is contributing his share for payment of premium to the Insurance Scheme. The petitioner is entitled to get general treatment as well as cashless treatment. On 02.02.2017, the petitioner was admitted at Ganga Medical Centre Hospital Pvt., Ltd., Coimbatore in an emergency condition. He underwent a surgery of BPH (Benivn Postrait Hypertrophy).
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.
In emergency situations, patients are not required to seek treatment only in a network hospital for medical reimbursement, as established by settled law.
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.
The main legal point established in the judgment is the obligation of the state to ensure timely medical treatment and the need for a compassionate and sympathetic consideration of medical reimbursem....
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.
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