MADURAI: The Madurai Bench of the Madras High Court recently directed an insurance company to pay Rs 1.22 lakh medical reimbursement to a corporation school teacher after the same was rejected by the company stating that she undertook treatment in a non-network hospital.
The teacher S Dhanalakshmi worked in a school run by Madurai Corporation. Owing to a gum infection, she had to undergo an emergency surgery in Nagercoil in a non-network hospital by spending Rs 1.22 lakh. Her application for reimbursement was initially rejected due to the said fact in 2018.
However, pursuant to a direction from the high court, her claim was reconsidered by the district level empowered committee the following year, and the committee directed that her claim should not be rejected. The recommendation remained unimplemented for two months, till a single judge of the court told the state government to disburse reimbursement amount to her within a month. Challenging this, the government filed an appeal.
When the appeal was heard by a bench of Justices GR Swaminathan and S Srimathy, the government counsel contended that the government cannot be saddled with financial liability to make reimbursement and that it is the insurance company that has to pay. However, the standing counsel for the insurance company strongly objected saying it cannot be held liable since the teacher's ailment was not emergent in nature and she took treatment in a non-network hospital.
The judges referred to a high court verdict which said that the insurance company cannot take a decision contrary to the recommendation made by a district level empowered committee. They also pointed out that the insurance company was also a party to the committee meeting and is therefore bound by the committee's decision. They directed the company to pay Rs 1.22 lakh to Dhanalakshmi within two months.