Madras High Court
The Divisional Manager vs Dr.S.Kalaiselvi on 25 September, 2024
Author: C.V.Karthikeyan
Bench: C.V.Karthikeyan
W.A(MD).No.531 of 2019
BEFORE THE MADURAI BENCH OF MADRAS HIGH COURT
Date : 25.09.2024
CORAM
THE HONOURABLE MR.JUSTICE C.V.KARTHIKEYAN
AND
THE HONOURABLE MS.JUSTICE R.POORNIMA
W.A.(MD)No.531 of 2019
and
C.M.P(MD)No.4486 of 2019
The Divisional Manager,
M/s.United India Insurance Co. Ltd.,
Divisional Office,
5th Floor, PLA Rathina Towers,
No.212, Anna Salai,
Chennai – 600 006. ... Appellant/Respondent
Vs.
Dr.S.Kalaiselvi ...Respondent/Writ Petitioner
PRAYER : Writ Appeal is filed under Clause 15 of the Letters Patent
against the order passed in W.P.(MD)No.11565 of 2016, dated
13.11.2018.
1/8
https://www.mhc.tn.gov.in/judis
W.A(MD).No.531 of 2019
For Appellant : Mr.G.Prabu Rajadurai
for Mr.A.Shajahan
For Respondent : Mr.G.S.Asok Adhithyan
JUDGMENT
The respondent in W.P.(MD)No.11565 of 2016 aggrieved
by the order of the learned Single Judge, dated 13.11.2018, by which
order, the learned Single Judge had allowed the writ petition and had also
directed the appellant herein to reimburse medical claim of Rs.2,29,515/-
to the writ petitioner/respondent herein and had restricted claim of
interest to 12% from the date of filing the writ petition which was dated
27.06.2016 and had stipulated a condition that the amount should be paid
within a period of 30 days and if not paid within 30 days, had directed
that the appellant herein shall pay the amount with 36% interest for the
said amount, has filed the present Writ Appeal.
2. The brief facts of the case are that the petitioner
Dr.S.Kalaiselvi was covered under Tamil Nadu Government's New
Health Insurance Scheme, 2012. Her daughter had been admitted in
https://www.mhc.tn.gov.in/judis
Kaveri Nagar Medical Centre at Tiruchirappalli for renal failure and
allied health problems. The writ petitioner had paid a sum of
Rs.2,29,515/- towards the treatment and later, sought reimbursement
from the appellant herein / respondent in the writ petition, United India
Insurance, Anna Salai, Chennai. It is also seen from the records that the
District Collector had constituted the District Empowerment Committee
to examine the grievance of the writ petitioner, since the claim was not
acted upon by the appellant herein. A Committee was constituted with
the District Collector, Joint Director Health and Rural Welfare and also
the District Treasury Officer as members. This Committee convened on
25.02.2015. The writ petitioner and a representative of the insurance
company/appellant herein were present and statements were recorded. It
was finally recommended that a sum of Rs.2,29,515/- should be paid by
the appellant herein/Insurance company.
3. It was the grievance of the writ petitioner that in spite of
such recommendation, the appellant herein had circulated a letter dated
22.11.2017 after the order of the District Empowerment Committee
seeking documents, namely, (i) for taking treatment in Kauvery Hospital
https://www.mhc.tn.gov.in/judis
and original cash receipts for a sum of Rs.1,30,000/- and (ii) for taking
treatment in Apollo Hospital and to produce original discharge summary,
original break-up bills of hospital, final bill, original hospital final bill
and original cash receipts.
4. The learned Single Judge had observed that even after the
recommendation by the District Empowerment Committee in the
proceedings of which the representative of the appellant had participated,
the letter issued by the Divisional Manager once again calling for the
aforementioned records would be an exercise akin to sitting as an
Appellate authority over the District Empowerment Committee and had
observed that this was impermissible and therefore, directed settlement of
the claim of the petitioner to the said sum of Rs.2,29,515/- together with
interest for a period of 30 days and if not paid within 30 days, with
interest at the rate of 36% p.a. Questioning that particular direction, the
present Writ Appeal has been filed.
5. We were quite surprised about the attitude of the appellant
herein in calling upon the respondent/writ petitioner to produce the bills
https://www.mhc.tn.gov.in/judis
for treatment already recommended by the District Empowerment
Committee and which recommendation had been issued only after
examining the bills produced by the writ petitioner herein.
6. We were therefore constrained to call upon the Divisional
Manager, United Insurance Company Ltd., Chennai to be physically
present. We also directed production of the recommendation of the
District Level Empowerment Committee and other relevant records
which had already been forwarded to the Divisional Office.
7. Accordingly, today, Mr.S.Sasi Kumar, Chief Manager,
Divisional Office VI, Regional Office Campus at Chennai is present
before us.
8. Mr.G.Prabhu Rajadurai, learned counsel addressed the
Court on behalf of the appellant, and it must be said to the credit of the
learned counsel, had understood the scope of the restriction in which the
appellant was placed and fairly stated that once the District Level
Empowerment Committee had recommended payment, there was an
https://www.mhc.tn.gov.in/judis
obligation on the appellant to pay the said amount. It is, therefore,
assured by the learned counsel that within a reasonable time, the claim of
the writ petitioner would be settled by the appellant.
9. The only issue is with respect to interest.
10. The learned Single Judge had directed interest at the rate
of 12% per annum, if the amount had been paid within 30 days and had
further stated that if not paid within 30 days, interest at the rate of 36%
p.a., would be paid. But in view of the stand now taken by the appellant
and the realisation of the appellant of their duty to discharge, we would
maintain a uniform rate of interest at 12% p.a., from the date of filing of
the writ petition, namely, 27.06.2016 till date of the actual settlement of
claim. The payment may be made directly in the name of the writ
petitioner, Dr.S.Kalaiselvi. Stating as above, since there has been some
relief granted to appellant with respect to the interest portion, we will
have to record that the writ appeal is partly allowed.
https://www.mhc.tn.gov.in/judis
11. With the above direction and observation, the Writ
Appeal is partly allowed. No order as to costs. Consequently, connected
miscellaneous petition is closed.
(C.V.K., J.) (R.P., J.)
25.09.2024
RM
https://www.mhc.tn.gov.in/judis
C.V.KARTHIKEYAN, J.
AND
R.POORNIMA, J.
RM
25.09.2024
https://www.mhc.tn.gov.in/judis
