Supreme Court - Daily Orders
The Chairman Cum Managing Director ... vs G. Latha on 22 July, 2021
Bench: D.Y. Chandrachud, M.R. Shah
1
ITEM NO.2 Court 5 (Video Conferencing) SECTION XII
S U P R E M E C O U R T O F I N D I A
RECORD OF PROCEEDINGS
Petition(s) for Special Leave to Appeal (C) No(s).374-379/2019
(Arising out of impugned final judgment and order dated 01-03-2018
in WASR No. 7594/2018, WASR No. 7598/2018, WASR No. 7606/2018, WASR
No. 7617/2018, WASR No. 7624/2018 and WASR No. 7631/2018 passed by
the High Court of Judicature at Madras)
THE CHAIRMAN CUM MANAGING DIRECTOR
UNITED INDIA INSURANCE CO. LTD. ETC. Petitioner(s)
VERSUS
G. LATHA & ORS. ETC. Respondent(s)
Date : 22-07-2021 These petitions were called on for hearing today.
CORAM :
HON'BLE DR. JUSTICE D.Y. CHANDRACHUD
HON'BLE MR. JUSTICE M.R. SHAH
For Petitioner(s) Mr. P.P. Malhotra, Sr. Adv.
Mr. Vineet Malhotra, Adv.
Mr. Mohit Paul, AOR
Mr. Vishal Gohri, Adv.
Ms. Sunaina Phul, Adv.
Mr. Shubhendu Kaushik, Adv.
For Respondent(s) Mr. R. Anand Padmanabhan, Adv.
Debarati Sadhu, Adv.
Mr. Shashi Bhushan Kumar, AOR
Dr. Joseph Aristotle S., AOR
Mr. Saaketh Kasibhatla, Adv.
Mr. G. Sivabalamurugan, AOR
Ms. Manju Jetley, AOR
Mr. K. V. Vijayakumar, AOR
Signature Not Verified
Mr. D. Kumanan, AOR
Digitally signed by
Sanjay Kumar
Date: 2021.07.23
Mr. Aman Shukla, Adv.
14:52:36 IST
Reason:
2
UPON hearing the counsel the Court made the following
O R D E R
1 A brief note of submissions has been filed on behalf of the State of Tamil Nadu. Annexure 2 to the submission is a copy of the DO letter No 37012/Fin(Salaries) Department/2019-1 dated 1 November 2019 of the Principal Secretary to the Government of Tamil Nadu in the Finance Department. Responding to a decision of the Madurai Bench of the High Court, the State Government has issued liberalized guidelines to govern claims for reimbursement of medical expenses incurred by employees, pensioners and family pensioners of the State Government. Clause 6 of the Guidelines covers four distinct situations, and are extracted below:
“I. For an approved treatment/surgery undertaken in a Network hospital, either a part of the claim or no claim has been settled by the Insurance Company.
II. For an approved treatment/surgery undertaken in a Non-
Network hospital for Emergency Care or following an accident.
III. For an unapproved treatment/surgery undertaken either in Network Hospital or Non-Network Hospital for Emergency Care or following an accident.
IV. For any treatment/surgery undertaken in a Non-Network hospital for Non-emergency care (or) for an unapproved treatment/surgery undertaken in a network hospital for Non-emergency care.”
2 Clause II covers an approved treatment/surgery undertaken in a Non-Network Hospital for Emergency Care or because of an accident. District level Committees have been set up to evaluate such claims under the guidelines. Clause (g) of the Guidelines pertaining to Category II is as follows:
“(g) If the Committee is satisfied that the patient has undertaken an approved treatment/surgery in a Non- Network Hospital under Emergency, then the Committee 3 shall pass order to direct the PAO/PPO/District Treasury Officer, within a period of 30 days from the date of receipt of application, to reimburse medical claim as per the package rate for that approved treatment/surgery undertaken in a similarly placed network hospital in and around the locality. If there is no such similarly placed network hospital in the locality, then the Committee shall identify any other similarly placed network hospital under the scheme in Tamil Nadu for reference.”
3 Dr Joseph Aristotle, Standing Counsel appearing on behalf of the State of Tamil Nadu, submits that the object of issuing these fresh guidelines is to substantially enhance the medical reimbursement which is available to the employees, pensioners and family pensioners as compared to the rates which were fixed under the Tamil Nadu Medical Attendance Rules.
4 In this backdrop, it has been submitted on behalf of the State of Tamil Nadu that if the respondent-pensioners move the District Level Empowered Committee in terms of the Guidelines of 2019, their case for reimbursement would be duly determined expeditiously. We accordingly direct that the respondents who are the claimants, shall, within a period of three weeks, submit their claims in terms of the revised guidelines of 2019 with necessary documentation to the District Level Empowered Committee constituted under the Guidelines. The Committee shall take its decision on the claims which have been submitted for reimbursement in terms of the Guidelines of 2019 as well as the further Guidelines dated 29 April 2021 issued under letter No 19022/Pension/2021-1 of the Additional Chief Secretary in the Finance (Pension) Department within a period of four weeks of the submission of claims. The State of Tamil Nadu shall, thereupon, reimburse the claims and file an affidavit indicating the decision which has been taken and the extent of reimbursement, if any, provided under the Guidelines of 2019 as well as the further Guidelines dated 29 April 2021 to each of the respondent – pensioners on account of medical reimbursement. The amount which is paid and accepted will be subject to the present proceedings 4 and without prejudice to the rights and contentions of parties. 5 Accordingly, we direct that these proceedings shall be listed for further hearing on 16 September 2021.
(SANJAY KUMAR-I) (SAROJ KUMARI GAUR)
AR-CUM-PS COURT MASTER