In a judgment that could help thousands of serving and retired government employees to freely undergo treatment for major ailments, the Madras High Court (Madurai Bench) has reiterated that the State cannot deny reimbursement to patients treated in “unlisted” hospitals.
Allowing a petition filed by a retired government staff N Chidambaram of Dindigul seeking reimbursement, Justice M M Sundresh pointed out that the very purpose of the Tamil Nadu Government Employees Health Fund Scheme (TNGEHFS) was to help employees when they suffer from ailments.
Chidambaram had undergone an angioplasty and PTCA surgery in November 2009. Later, he applied for reimbursement of medical expenses for `1.94 lakh under the TNGEHFS. However, his application was rejected on the grounds that the surgery undertaken by him was not emergent and the hospital in which it was performed figure among the listed hospitals mentioned in the Government Order (GO Ms No 377) of the Finance Department issued in October 2005. Hence Chidambaram approached the court.
Accepting his plea for reimbursement, Justice Sundresh pointed out that a single judge had earlier given an order stating that when a person is struggling for life he or his family members cannot be expected to search for a recognised hospital wasting the “golden hour”. The idea to get the medical reimbursement will not certainly strike in their mind at that point of time so as to search for listed hospitals.
The judge said in the case of K Balaswami Vs Director of Pension, Chennai and Another, the court had held that medical reimbursement should not be denied on the ground that the petitioner failed to undergo heart surgery in the hospital recognised by Government of Tamil Nadu. In view of this,
Justice Sundresh directed the respondents to reimburse the medical expenses to Chidambaram within eight weeks.