Retired BSNL Officer’s ₹5.65 Lakh COVID Claim: CAT Directs Authorities To Verify Hospital/TPA Records And Settle Admissible Amount Within 2 Months

The applicant, a retired BSNL Assistant General Manager, sought reimbursement of ₹5,65,586 for emergency inpatient treatment for Covid-19 at Dr. Rela Institute and Medical Care Centre, Chennai, from 12 to 27 December 2021.

He submitted his claim and later-provided documents, but BSNL declined to process it because original receipts/vouchers had not been submitted.

The respondents also stated that the treatment was covered under a medical insurance policy and that claims had been addressed to the insurer’s TPA, rather than the employee.

After representations went unanswered, the applicant filed this O.A.

The Tribunal relied on the Supreme Court’s decision in Shiva Kant Jha v. Union of India (13 April 2018), referring to medical reimbursement as a statutory right that cannot be denied on technical grounds.

It also proceeded on the basis that, under the applicable policy, the respondents could independently verify the claim and determine the admissible amount not paid by the insurance company.

The Tribunal considered that the respondents’ objection concerned the absence of original vouchers, while the claim had been processed through the hospital and VIDAL HEALTH TPA.

It held that the respondents could verify the bills directly with the hospital or through the TPA and ascertain what amount, if any, remained admissible and unpaid by the insurer.

In light of the principle in Shiva Kant Jha, the technical objection should not prevent the claim from being examined and settled.

If they failed to do so, the applicant would be entitled to interest at GPF rates on the amount determined to be payable, for the period of delay after expiry of those two months.

No order as to costs was made.