HC slams govt for rejecting pensioner’s med reimbursement

Hearing a petition by a pensioner who was forced to approach the court for a second time despite several court rulings reiterating that a claim cannot be rejected for undergoing treatment at a non-network hospital Justice N Anand Venkatesh said “In every case, it looks as if the authorities are trying to find some reason to either reject the claim or to arbitrarily fix some amount as against the actual claim made.”

“A welfare state is gauged in the way it treats its senior citizens. If they are going to be treated in this manner, it will portray the State in a very poor light. This court is pouring its agony daily in cases of this nature with a fond expectation that the authorities will act upon such claim for medical reimbursement in a more humane manner,” the judge said.

The court also expressed its pain to note that pensioners were not being treated properly, and directed the Finance (Pension) department Principal Secretary to settle the balance amount of Rs 2.16 Lakh, within four weeks.

After being diagnosed with “Adenomatous Polyp with Dysplasia” in 2014, the petitioner, A Shanmugam, immediately underwent a surgery.

After settling the medical bill of Rs 2.74 Lakh, he claimed reimbursement, which, however, was rejected in 2018 on the ground that he took treatment in a non-network hospital. As his repeated representations evoked no action, Shanmugam moved the High Court, which set aside the ground of rejection as unsustainable.

But when the government failed to pay the amount within eight weeks as directed, he moved a contempt plea. When notice was issued to authorities, Shanmugam was granted Rs 57,860 as against the claim of Rs 2.74 Lakh, forcing him to move the court again.

Observing that pensioners cannot afford to spend huge amounts towards medical expenses and were wholly dependent on the General Insurance scheme, Justice Anand Venkatesh pointed out that the court has repeatedly held that a claim can never by rejected on the ground that the treatment was done in a non-network hospital.

“When a person is facing emergency, it will be too much to expect the person who is undergoing agony and his family to choose a hospital which is listed under the Government Order,” he added, noting that what was required to be considered was whether the claim was genuine.