Covid Patient Given 4 Weeks To Apply For ₹2.25 Lakh Reimbursement; Namakkal Panel Must Decide Within 8 Weeks: Madras HC

The petitioner sought medical reimbursement for treatment of COVID-19, stating that he had incurred expenses of ₹2,25,831; the writ petition sought reimbursement of ₹2,25,000 with interest, based on a representation dated 22 January 2024.

The respondents submitted that the District Level Empowered Committee was the appropriate authority to consider the claim.

The Court suo motu impleaded the Namakkal District Level Empowered Committee as the third respondent.

Whether the petitioner’s medical reimbursement claim should be considered by the District Level Empowered Committee.

Whether the Court should directly order reimbursement, or instead direct the petitioner to apply to the Committee for consideration of the claim.

Under S. Marimuthu v. Government of Tamil Nadu and Others, W.P. (MD) No. 13429 of 2013 etc., batch, paragraph 80, medical reimbursement claims are to be reconsidered by the concerned District Level Empowered Committee; claims should not be rejected merely because treatment was at a non-network hospital or concerned a non-listed disease.

The Committee may direct the insurer to reimburse the claim or, where appropriate, recommend reimbursement by the State under the Medical Attendance Rules.

The precedent also provides for reimbursement with 6% interest in the circumstances specified in its directions.

The present order applied that framework by referring the petitioner’s claim to the Committee for consideration.

The Court accepted the respondents’ submission that the District Level Empowered Committee was the proper authority to consider the reimbursement claim, consistent with the procedure outlined in S. Marimuthu.

Rather than determine the petitioner’s entitlement or the amount payable, the Court impleaded the Namakkal Committee and directed the petitioner to submit an application with the required documents, leaving the merits for the Committee’s consideration.

It directed the petitioner to apply to the District Level Empowered Committee, Namakkal District, with the requisite documents within four weeks of receiving the order; the Committee must consider the application and pass appropriate orders within a further eight weeks. No costs were awarded.