Medical reimbursement claims for government employees cannot be denied based on technicalities; the genuinity of treatment must be verified, and claims should be settled promptly.

[Judgment of the Court was made by S.M.SUBRAMANIAM, J.]

These appeals have been preferred challenging the orders passed by the writ Court on 17.10.2019, 28.05.2019, 18.12.2020, 16.12.2020 and 27.02.2017 respectively. The issue relating to medical reimbursement claim of the Government employees.

2.Admittedly, the scheme for medical reimbursement has been issued by the Government and accordingly, a separate contract was entered into between the Government and Insurance Company.

Consequently, the Insurance Company has to settle the medical reimbursement claims of the eligible Government employees, who all are submitting applications. Dispute arises regarding certain claims objected by the Insurance Company. However, Courts have consistently held that medical reimbursement claims cannot be rejected merely on the hyper technical grounds. Even if the treatment has been taken in an unapproved hospital, the authorities are bound to verify the genuinity of the treatment taken by the government employee and settle the medical reimbursement claim. Therefore, treatment taken only in listed hospital alone cannot be said to be eligible but the nature of treatment and its genuinity ought to be considered for the purpose of settling medical reimbursement claim of the respective applicants. That apart, it is further settled that there should not be any delay in settling the medical reimbursement claim. On receipt of application, the Insurance Company at the first instance shall scrutinize the same and settle the eligible claims.

3.Courts have passed several orders to settle medical reimbursement claims of the applicants even if the treatments are taken in non listed hospitals. Similarly, certain treatments which all are consequential or connected with the treatment contemplated under the government orders are also held to be eligible for reimbursement claim. Since all these issues are settled, it is unnecessary for this Court to reiterate the same.

4.The learned Single Judge in the impugned order elaborately considered all these aspects and directed the respondents in the writ proceedings to ascertain the facts and settle the medical reimbursement claims, as follows:

"80. In order to reconsider all these claim made by the respective writ petitioners for medical reimbursement, by remitting the matters back, the following directions are issued:

(i) All the impugned orders in the respective writ petitions in this batch of cases, are hereby quashed.

(ii) The writ petitions where impugned orders are quashed as well as the writ petitions where mandamus sought for, are hereby remanded with directions to the concerned District Level Empowered Committee, before whom, these matters shall be placed and the Committee shall reconsider every individual case.

(iii) While reconsidering, the Committee shall not reject any claim merely on the reason of non network hospital or non listed disease.

(iv) The Committee, wherever possible, shall give suitable direction to the Insurance Company to reimburse the claim made by the respective claimant / employee / pensioner.

(v) If the Committee finds some cases where the Insurance Company cannot be directed to reimburse, in those cases, suitable orders shall be passed directing / recommending the State authorities to reimburse the claim under Medical Attendance Rules.

(vi) Once such orders are passed, the Insurance Company shall immediately reimburse the medical claim with 6% interest from the date of due till date of payment, within a period of thirty days from the date of receipt of such order to be passed by the Empowered Committee of the District concerned.

(vii) On receipt of such orders / recommendation from the Empower