Chennai: A 72-year-old retired government employee, who has been waging a war against United India Insurance Co. Ltd. for over two years to get reimbursement of his medical bill to the tune of Rs 1.44 lakh spent for treatment of chest pain, got reprieve with the Madras high court directing the insurance company to reimburse the amount and imposed a cost of Rs 50,000 on the company.
Allowing a petition from the retired employee K.P. Ramalingam, Justice T. Raja said, “Although P. Sankaranarayanan, counsel for the United India Insurance company requested not to impose costs as this would certainly demoralise the name of the insurance company, this court is not inclined to accept such submission, in my considered opinion, it would amount to justification of the wrong done by the Insurance company, as such, the very purpose of the scheme would get defeated.”
Petitioner’s counsel K.R. Ravindran submitted that petitioner has been receiving a pension. The state government had issued a G.O dated June 26, 2014, introducing New Health Insurance Scheme for pensioners. The petitioner had also subscribed to the said scheme so as to get health insurance benefits. On December 5, 2014, due to chest pain, the petitioner was admitted into the Christian Medical College Hospital in Vellore, which was one of the approved hospitals under the said scheme. The petitioner was discharged on December 8, 2014, on payment of Rs 1, 43, 709. But, the insurance company has not settled the amount even after two years on, the only ground that the petitioner had not submitted the original break up bills. Therefore, the petitioner has filed the current petition, Ravindran added.
The judge said denial by the Insurance company to pay the reimbursement of the medical bill amount under the said scheme, that too, even after the receipt of the recommendation of the Joint Director of Medical and Rural Health Services, Vellore, as well as the recommendation of the Empowered Committee for reimbursement presided by the District collector, was wholly unjustifiable and bereft of any merit. “Therefore, the petition is allowed with costs of Rs 50,000 payable by the insurance company to the petitioner along with the reimbursement amount of Rs 1,43,709 within 4 weeks”, the judge added.
