The Madras High Court Bench here has directed the government to reimburse Rs.44,581 spent by a Madurai Corporation Middle School teacher for performing obstructed hernia surgery on her 10-month-old son at a private hospital that was not part of a network of hospitals listed under the health insurance scheme for government employees.
Allowing a writ petition filed by S. Dhanalakshmi, who was denied reimbursement, Justice R. Subbiah said the petitioner could not be expected to go in search of network hospitals in situations of emergency as she would be worried more about saving the life of her child than complying with insurance conditions.
The judge quashed an order passed by the United Insurance Company on January 8, 2015, rejecting her claim for reimbursement, and directed the government to make sure that the amount was reimbursed along with interest at the rate of nine per cent from April 30, 2014, when she had made the payment to the private hospital, to the date when the money would be handed over to her.
In her affidavit, the petitioner said that the government had been regularly deducting the premium for the insurance scheme from her monthly salary since 2012. Her son suffered from continuous vomiting on April 22, 2014, and she initially ignored it presuming it to be due to food poisoning. However, when his condition worsened the next day, she rushed him to a nearby doctor.
On diagnosis, the doctor at the private hospital insisted that the child should be operated upon immediately for obstructed hernia failing which his condition might worsen. Hence, she hurriedly wrote a letter to the Collector and obtained permission to relieve her from Parliamentary election duty in order to attend to her son during the surgery that took place on April 23, 2014.
Subsequently, she was called upon by the Commissioner of Treasuries and Accounts as well as a team comprising the Collector and insurance officials to prove the claim for reimbursement. She appeared before them in July and November 2014 respectively and produced the hospital bills. Yet, her request was rejected on the ground that the surgery was not performed in a network hospital.
