Mohamed Imranullah S.
|They cannot be denied reimbursement for treatment in hospitals not enlisted in schedule|
MADURAI: Hundreds of Government employees, who were denied medical reimbursement for undergoing treatment in hospitals not enlisted in the schedule prescribed by the employer, now have a reason to smile.
Passing common orders on writ petitions filed by a police sub-inspector from Thanjavur and a retired Madurai Corporation employee recently, Justice P. Jyothimani of the Madurai Bench of the Madras High Court ruled that hospitals listed in the schedule were illustrative and not exhaustive in nature.
One could not expect the families of the employees to search for the hospital listed in the schedule, especially when the patient needed expeditious treatment. Such a demand would be "inhumane" and "totally opposed" to the basic purpose of offering medical reimbursement schemes.
On the contention by the Special Government Pleader that the schedule had been prepared as a matter of policy, Mr. Justice Jyothimani said: "There cannot be a policy of the Government to fix a particular hospital alone or a list of hospitals... but it can only be relating to providing medical treatment... When that is the object of the scheme one cannot restrict it by listing the hospitals."
The judge directed the petitioners' employers to reimburse the amount spent by them subject to the maximum amount to which they were entitled to under the respective schemes.
Police health fund
The sub-inspector counsel, S. Nagamuthu, said his client was a beneficiary under the Tamil Nadu Police Health Fund (TNPHF), and eligible for medical reimbursement of Rs. 1 lakh.
When he was afflicted with sub acute organic brain syndrome and underwent major surgeries, totally costing Rs. 3,67,428, at a reputed private hospital in Chennai, the department refused to provide him financial assistance claiming that the hospital was not listed in the schedule.
Pointing out that police personnel were even eligible to undergo treatment in a foreign country under the TNPHF, counsel wondered how could the Government deny reimbursement.
The retired Corporation employee's counsel, R. Singaravelan, contended that his client was entitled to a maximum of Rs. 50,000 or 75 per cent of medical expenditure under the Municipal Pensioners' Health Fund.
He underwent heart surgery at a private hospital here at a cost of Rs. 1,23,730. But, the officials refused to reimburse any amount because the hospital was not listed in the schedule.
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