Madras high court quashes orders on medical reimbursement for state employees
Chennai: The Madras high court has quashed the orders passed by the authorities, rejecting the claim of the employees and pensioners of the state government and its undertakings to grant medical reimbursement under the New Health Insurance Scheme implemented by the state government from time to time.
Passing orders on a batch of petitions filed from the year 2013 onwards, from S.Manimuthu and others, Justice R.Suresh Kumar remitted the matter back to the District Level Empowered Committee concerned to reconsider every individual case.
“While reconsidering, the committee shall not reject any claim merely on the reason of non-network hospital or non-listed disease. The Committee, wherever possible, shall give suitable direction to the Insurance Company to reimburse the claim made by the respective claimant/employee/pensioner”, the judge added.
The judge said 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. “Once such orders are passed, the Insurance Company shall immediately reimburse the medical claim with 6 percent 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”, the judge added.
The judge said on receipt of such orders/recommendation from the Empowered Committee, the Sanctioning authority/state authority/high power committee in the state level shall pass necessary orders allowing the medical reimbursement claimed by the individual claimant/employee/pensioner under the Medical Attendance Rules. While ordering medical reimbursement under Medical Attendance Rules, the rate approved, accepted or quoted by the Insurance Company under the Medical Insurance Scheme shall be taken as the rate and by calculating the reimbursement on the said rate, the reimbursement claim shall be immediately sanctioned and the amount shall be reimbursed to the claimant with 6 percent interest from the date of due till date of payment, within a period of thirty days from the receipt of the recommendation/order from the District Empowered Committee, judge added.
Citing several judgments, the judge said when the employee or pensioner availed a treatment in a non-network hospital whether the said treatment was taken out of emergency or not cannot be decided easily sitting in administrative desk by perusing the papers.
