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HIGH COURT OF JUDICATURE AT MADRAS
Honourable Mr Justice K.KUMARESH BABU
N. KALAIYARASAN, – Appellant
Versus
THE STATE OF TAMIL NADU – Respondent
WP(MD)/15423/2014
Insurance companies are obligated to reimburse medical expenses as per the terms of the insurance policy and any delay in reimbursement may result in legal action.
Headnote:
HEALTH INSURANCE - REIMBURSEMENT - DELAY - The court directed the insurance companies to disburse the amount claimed by the petitioner within eight weeks from the date of receipt of the order.
Fact of the Case:
The petitioner, a Mazdoor Grade-II employee, had enrolled in an insurance scheme with the respondents for medical facilities. His son met with an accident and was taken to a hospital where the petitioner incurred medical expenses of Rs.1,66,022/-. The petitioner made a claim for reimbursement, and the 2nd respondent recommended the disbursement of the amount to the 3rd respondent. However, the reimbursement was not effected by the 3rd and 4th respondents.
Finding of the Court:
The court directed the 3rd and 4th respondents to disburse the amount claimed by the petitioner, pursuant to the recommendations made by the 3rd respondent, within a period of eight weeks from the date of receipt of a copy of the order.
Issues: Delay in reimbursement of medical expenses under health insurance scheme.
Ratio Decidendi: The court relied on the recommendation made by the 2nd respondent for disbursing the amount to the 3rd respondent.
Final Decision: The court directed the insurance companies to disburse the amount claimed by the petitioner within eight weeks from the date of receipt of the order.
W.P.(MD)No.15423 of 2014
BEFORE THE MADURAI BENCH OF MADRAS HIGH COURT
DATED :06.01.2023
CORAM
THE HONOURABLE MR.JUSTICE K. KUMARESH BABU
W.P.(MD)No.15423 of 2014
N.Kalaiyarasan
... Petitioner
Vs.
1.The State of Tamil Nadu
Rep by its Principal Secretary to Government,
Finance (Salaries) Department,
Secretariat, Chennai 600 009.
2.The Superintending Engineer,
Tamil Nadu Generation and Distribution
Corporation Ltd.,
Tamil Nadu Electricity Board,
Kanyakumari Electricity Distribution Circle,
Nagercoil, Kanyakumari District.
3.The Managing Director,
India Medical Insurance Scheme,
No.27, Lakshmi Tower 2nd Floor,
Radhakrishna Road,
Chennai-04.
4.The Deputy Manager,
United India Insurance Company Ltd.,
Divisional Office,
Silingi Buildings,
No.134, Greams Road, Chennai 600 006.
... Respondents
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W.P.(MD)No.15423 of 2014
PRAYER : Petition filed under Article 226 of the Constitution of India
praying for issuance of Writ of Mandamus, to direct the respondents 3 and 4
to pass orders on the petitioner's representation dated 28.08.2012 which was
forwarded by the 2nd respondent in Letter No.022856/Ni.Pi.1/Pi.3/2013
dated 20.02.2013 and to reimburse the amount of Rs.1,46,022/- (Rupees
One Lakh Forty Six Thousand and Twenty two only) to the petitioner's
which was paid by his to the approved Hospital under the Health Insurance
Scheme, 2012 for the petitioner's son Selvan.K.Muthu Manikandan within a
stipulated time may be fixed by this Court.
For Petitioner
:Mr.M.Saravanakumar
For Respondents
:Ms.D.Farjana Ghoushia
Special Government Pleader for R1
:Mr.S.Arivalagan for R2
:No appearance for R3 & R4
O R D E R
This writ petition is filed seeking for a mandamus to direct the 3rd
and 4th respondents to reimburse the medical expanses based on the
petitioner's representation dated 28.08.2012.
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W.P.(MD)No.15423 of 2014
2.The learned counsel for the petitioner would submit that the
petitioner is working as a Mazdoor Grade-II under the control of the 2nd
respondent. Towards the medical facilities, the petitioner had been enrolled
in an insurance scheme with the 3rd and 4th respondents and he has been
paying subscription regularly. While so, his son has met with an accident
and was taken to the nearest Multi Care Hospital namely Dr.Jeya Sekaran
Hospital, Nagercoil. He had expended a sum of Rs.1,66,022/- and that he
had made a claim for the same. The 2nd respondent herein, by his
communication dated 20.02.2013 had made a recommendation for
disbursing the amount to the 3rd respondent herein. Inspite of the
recommendation made, the reimbursement has not been effected by the 3rd
and 4th respondents. Hence, he had approached this Court.
3.Inspite of the notice to the 3rd and 4th respondents, either they
have appeared in person or through their counsel.
4.Considering the prayer that sought for in this writ petition, the
3rd and 4th respondents are directed to disburse the amount as claimed by the
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W.P.(MD)No.15423 of 2014
petitioner, pursuant to the recommendations made by the 3rd respondent,
within a period of eight weeks from the date of receipt of a copy of this
order.
5.In view of the aforesaid direction, this writ petition stands
disposed of. There shall be no order as to costs.
06.01.2023
Index : Yes / No
Speaking Order/Non Speaking Order
sbn
To
1.The State of Tamil Nadu
Rep by its Principal Secretary to Government,
Finance (Salaries) Department,
Secretariat, Chennai 600 009.
2.The Superintending Engineer,
Tamil Nadu Generation and Distribution Corporation Ltd.,
Tamil Nadu Electricity Board,
Kanyakumari Electricity Distribution Circle,
Nagercoil, Kanyakumari District.
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W.P.(MD)No.15423 of 2014
K.KUMARESH BABU, J.
sbn
W.P
