Case Note & Summary
The case involved a writ appeal filed by Star Health and Allied Insurance Company Ltd. against a writ order dated 16.11.2022 concerning a claim for medical reimbursement by the first respondent, H. Selvaraj. The respondent underwent treatment for a medical condition at NIMS Heart Foundation and incurred expenses amounting to Rs.1,04,079/-. The insurance company denied the claim, asserting that the treatment was not conducted in an approved hospital and that an emergency was not established. The matter was referred to the District Level Empowered Committee, which recommended reimbursement of Rs.1,40,602/-, which was subsequently sanctioned and credited to the respondent's account. The Commissioner of Treasuries and Accounts confirmed that the reimbursement had been settled in favor of the respondent, thus indicating compliance with the court's previous order. The court found that since the reimbursement had been settled, nothing remained in the writ appeal, leading to the decision to set aside the earlier writ order and allow the appeal. The connected miscellaneous petition was also closed.
Headnote
A) Administrative Law - Medical Reimbursement - Claim for medical reimbursement under Tamil Nadu Medical Attendance Rules - The appellant repudiated the claim on grounds of treatment not being in an approved hospital and lack of emergency - The court found that the respondent was entitled to reimbursement as per the rules, and the amount was sanctioned by the District Level Empowered Committee. Held that the previous order was complied with and the appeal was allowed (Paras 2-4).
Issue of Consideration
Whether the appellant's repudiation of the medical reimbursement claim was justified.
Final Decision
The writ order dated 16.11.2022 was set aside, and the writ appeal was allowed, closing the connected miscellaneous petition.
Law Points
- Medical reimbursement
- Tamil Nadu Medical Attendance Rules
- Writ Appeal
- District Level Empowered Committee
- Compliance with court orders
