Case Note & Summary
The petitioner, P. Lakshmi, is an Assistant at the Principal District Court, Villupuram, and a member of the New Health Insurance Scheme (NHIS) administered by United India Insurance Co. Ltd. She was admitted to E.S. Hospital, Villupuram on 30.03.2024 for treatment of closed distal femur fracture right (Muller type A1) and rheumatoid arthritis, and was discharged on 04.04.2024. She incurred medical expenses of Rs.1,25,292/-. She intimated the insurance company about the treatment in 2024 itself, but the formal application for reimbursement was submitted to the Joint Director of Health Services on 09.04.2025. The insurance company rejected the claim on 29.11.2024, and the Joint Director rejected it on 21.04.2025, citing delay in submission. The petitioner challenged these orders by way of a writ petition. The Court observed that the petitioner had informed the insurance company about the treatment in 2024, and therefore the rejection on the ground of delay in submitting the formal application was not justified. The Court held that the petitioner is entitled to reimbursement of the medical bills with interest at 6% per annum from the date of the claim until the date of payment. The impugned orders were quashed, and the respondents were directed to process and disburse the reimbursement within eight weeks.
Headnote
A) Medical Reimbursement - Government Servant - New Health Insurance Scheme - Rejection on Procedural Delay - Petitioner, a government servant, was hospitalized and underwent surgery; she intimated the insurance company about the treatment in 2024 itself but submitted the formal application later in 2025. The insurance company and the Joint Director rejected the claim citing delay. The Court held that since the treatment was intimated within time, the rejection on the ground of delay in submitting the application is not sustainable. The Court directed reimbursement of the medical bills with interest at 6% per annum. (Paras 1-6)
Issue of Consideration
Whether the rejection of medical reimbursement claim on the ground of delay in submitting the application is sustainable when the treatment was intimated to the insurance company within time.
Final Decision
The writ petition is allowed. The impugned orders dated 29.11.2024 and 21.04.2025 are quashed. The respondents are directed to reimburse the medical bills of Rs.1,25,292/- with interest at 6% per annum from the date of claim until the date of payment, within eight weeks from the date of receipt of a copy of this order.
Law Points
- Medical reimbursement
- Government servant
- New Health Insurance Scheme
- Procedural delay
- Substantial compliance
- Interest
Case Details
2026 LawText (MAD) (06) 164
W.P.No.31277 of 2025 and W.M.P.No.35007 of 2025
S.M.Subramaniam, N.Senthilkumar
Mr.N.Palanikumar for Petitioner; Dr.R.Gouri, Govt. Counsel for R1,3 & 4; Ms.B.Poongkhulali for R2; Mr.N.Venkatraman for M/s.Nageswaran & Narichania for R5
The District Collector, Villupuram District; The Principal District Judge, Principal District Court, Villupuram District; The Joint Director of Health Services, Villupuram; The District Treasury Officer, District Treasury, Villupuram; The Authorised Officer, United India Insurance Co. Ltd., Chennai
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Nature of Litigation
Writ petition under Article 226 of the Constitution of India challenging orders rejecting medical reimbursement claim.
Remedy Sought
Quashing of orders dated 29.11.2024 and 21.04.2025, and direction to respondents to reimburse medical bills of Rs.1,25,292/- with interest at 9%.
Filing Reason
Rejection of medical reimbursement claim on ground of delay in submitting application despite intimation of treatment within time.
Previous Decisions
Insurance company rejected claim on 29.11.2024; Joint Director of Health Services rejected on 21.04.2025.
Issues
Whether rejection of medical reimbursement claim on ground of delay in submitting application is sustainable when treatment was intimated to insurance company within time.
Submissions/Arguments
Petitioner argued that she intimated the insurance company about the treatment in 2024 itself, and the delay in submitting the formal application was not fatal.
Respondents argued that the application was submitted belatedly and therefore the claim was rightly rejected.
Ratio Decidendi
When a government servant has intimated the insurance company about the treatment within time, the subsequent delay in submitting the formal application for reimbursement cannot be a ground to reject the claim. Substantial compliance with the procedural requirement is sufficient.
Judgment Excerpts
Petitioner had informed about the treatment taken by her to United India Insurance Co. Ltd., who in turn advised her to place the application before District Level Committee for consideration.
Therefore, it is not as if petitioner had not informed about treatment taken by her in April, 2024.
The rejection of the claim on the ground of delay in submitting the application is not sustainable.
Procedural History
Petitioner was hospitalized from 30.03.2024 to 04.04.2024. She intimated the insurance company in 2024. Insurance company rejected claim on 29.11.2024. Joint Director rejected on 21.04.2025. Petitioner filed writ petition on 10.06.2026.
Acts & Sections
- Constitution of India: Article 226
