‘Cannot make Reasons to deny Medical Insurance for Elderly’: High Court

The Madras HC has pulled up the authorities concerned for refusing to pay the full cost for treatment taken at a non-network hospital. “Admittedly,  in this case the petitioner is a contributory to the general insurance scheme &and the contributions are being deducted from his monthly pension. The pensioners at that age can't afford to spend huge amounts towards medical expenses & therefore, they are wholly dependent on the General Insurance scheme,” said justice Anand Venkatesh.  

“This Court has repeatedly held that a claim can never by rejected on the ground that the treatment/operation was undergone in a non-network hospital. When a person is facing emergency, it will be too much to expect the person who is undergoing agony & his family to choose a hospital which is listed under the govt order.  At that crunch moment, everyone will be more focused on saving the life of the person concerned than searching for listed hospitals,” he said. 

“In every case, it looks as if 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 manner in which it treats its senior citizens. If the senior citizens are going to be treated in this manner, it will portray the State in a very poor light. This Court is pouring its agony on a daily basis 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 added.

The judge was allowing a writ petition from A Shanmugam seeking to quash an order of the Finance (Pension) department dated Oct 3, 2019 refusing to settle the medical bill raised by him fully, on Feb 14. The judge set aside the part payment order, & directed the authorities to settle the balance amount of Rs 2.16 lakh due to the petitioner within four weeks.

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