Madras HC took critical note over the manner in which a Senior Citizen was constrained to repeatedly approach the court for the payment of his Medical Insurance Claim

A critical note over the manner in which a senior citizen was constrained to repeatedly approach the Court for the payment of his medical insurance claim was taken by the Madras High Court recently. The High Court held that, “A welfare State is gauged in the manner in which it treats its Senior Citizens. If Senior Citizens are going to be treated in this manner, it will portray the State in a very poor light.”

Prior facts

The petitioner, one A Shanmugam was diagnosed with “Adenomatous Polyp with Dysplasia” in 2014. Following this the petitioner immediately underwent surgery. The petitioner settled the medical bill of around Rs. 2.74 lakhs, after which he claimed for reimbursement. The reimbursement was however rejected back in 2018 stating the ground that the petitioner underwent treatment in a Non-Network Hospital. As a result the petitioner moved to the High Court, the High Court set-aside the ground of rejection saying that it was unsustainable.

Even after the order of the High Court, when the Government failed to pay him the amount within eight weeks, the petitioner again moved to the High Court with a Contempt plea. When the High Court issued notice to the authorities, the petitioner was granted a reimbursement of Rs. 57,860 as against the original claim of Rs. 2.74 lakhs. As a result the petitioner was again forced to move to the High Court.

Key Features

  • The High Court directed the Finance (Pension) Department Principal Secretary, to pay the outstanding amount of Rs. 2.16 lakh within four weeks.
  • A reimbursement claim cannot be rejected on the ground that the treatment/surgery was done in a Non-Network Hospital.
  • The Court opined that such claims of reimbursement should be handled in a much more humane manner.

The High Court’s order

Justice N Anand Venkatesh of the Madras High Court, expressing his disapproval over the situation stated that, “This is yet another unfortunate case, where a pensioner has been made to knock the doors of this Court for the 2nd time. This Court has been repeatedly passing orders on a daily basis in cases of this nature and it is painful to note that the old aged pensioners are not being treated properly and they are not even being settled with their legitimate claim for medical reimbursement.”

The Court was of the opinion that in such cases of reimbursement, where senior citizens are involved, the only consideration should be whether the claim is genuine or not. To this the Court said, “In every case, it looks as if the authorities are trying to find some reason to either reject the claim or to arbitrarily fix some amount as against the actual claim made. A welfare State is gauged in the manner in which it treats its Senior Citizens. If Senior Citizens are going to be treated in this manner, it will portray the State in a very poor light.”

The Court was of the opinion that, in such cases, the authorities should act upon medical reimbursement claims in a much more humane manner. The Court said that there was no merit on the ground upon which the reimbursement claim was rejected, hence the Court directed the Finance (Pension) Department to reimburse the outstanding amount of Rs. 2.16 lakhs to the aged petitioner. The Madras High Court also pointed out that, the Court has repeatedly settled the fact that, medical reimbursement claims cannot be rejected on the ground that the treatment/surgery was undergone in a Non-Network Hospital. The High Court directed the authorities to settle the balance amount claimed by the petitioner within four weeks from the date of receipt of the order.

Edited by J. Madonna Jephi

Approved & Published – Sakshi Raje

Reference

1. A Shanmugam v. Principal Secretary to Government & Ors., Writ Petition No. 611 of 2020.

Sanjivan Chakraborty
I'm Sanjivan Chakraborty pursuing B.A.LL.B (Hons.) at National Law University and Judicial Academy, Assam. Amused by the subject every ambit of legal study regals me. Mostly occupied with research-based studies and works. Other than law only volleyball and football can divert my attention."