Central Information Commission
Syed Rahiman I vs United India Insurance Co. Ltd. on 22 August, 2025
के ीय सूचना आयोग
Central Information Commission
बाबा गंगनाथ माग, मुिनरका
Baba Gangnath Marg, Munirka
नई िद ी, New Delhi - 110067
File No: CIC/UIICL/A/2024/108777
Syed Rahiman I .....अपीलकता/Appellant
VERSUS
बनाम
CPIO,
United India Insurance Co.
Ltd., Regional Office, 134,
Silingi Buildings, Greams
Road, Chennai - 600006 .... ितवादीगण /Respondent
Date of Hearing : 04.08.2025
Date of Decision : 22.08.2025
INFORMATION COMMISSIONER : Vinod Kumar Tiwari
Relevant facts emerging from appeal:
RTI application filed on : 21.11.2022
CPIO replied on : Not on record
First appeal filed on : 03.04.2023
First Appellate Authority's order : 30.10.2023
2nd Appeal/Complaint dated : 13.03.2024
Information sought:
1. The Appellant filed an RTI application dated 21.11.2022 (offline) seeking the following information:
"1. I have applied for reimbursement of medical expenditure incurred by me at Kovai Kuppusamy Naidu Hospital.Page 1 of 7
2. My application was sent with recommendation by Director, Welfare, Namakkal vide his letter Na.Ka. No. 5364/Miku/2020 dated 04.11.2022 for further action. I have enclosed the copy of the letter.
3. I humbly request that my application may be considered sympathetically and reimburse the medical expenditure incurred by me.
4. My application was considered and sent. I humbly request that the information about the details of the consideration made may be furnished under Right to Information Act, 2005."
2. Not having received any response from the CPIO, the appellant filed a First Appeal dated 03.04.2023. The FAA vide its order dated 30.10.2023, held as under:
"We acknowledge the receipt of your appeal under RTI. We hereby furnish the information received by us from DO 6 who is the holder of the information.
We would like to inform you that, the treatment taken in GKNM, Coimbatore is a covered procedure in an non network hospital as per the GO 171 dated 26/06/2014. The NHIS 2014 Pensioners scheme is only on Cashless basis and no reimbursement is allowed as mentioned in point no 11(g) of GO.171 dated 26/06/2014 issued by Finance (Pension) Dept."
3. Feeling aggrieved and dissatisfied, appellant approached the Commission with the instant Second Appeal on the following grounds:
"Facts Leading to Second Appeal to the Honourable CCI I am a petitioner aged 85 years residing in the above address. I am a retired Tamilnadu Government pensioner with PPO No. A/834674/Education and duly registered as a member in Tamilnadu Government Pensioners new health Insurance scheme 2OL4 with ID Card No. NMKf[/NHISP14/0063947. During 13.11.2015 I suddenly fell ill and became unconscious as my heart beat fell below 32. In view of Emergency I was taken to G.Kuppusamy Naidu Memorial Hospital, Coimbatore-641 037. Due to the exigency, amount was spent towards medical expenses relating to implantation of pace maker by me to the tune of Rs 2,23,864/- which was borrowed from my friends and relatives. I was fitted with pace maker. I was then discharged.
I applied for reimbursement of the medical expenses. After series of representations, the District Collector Namakkal was met on 04.08.2016 vide directions contained in na.Ka.No.647lmakul2}L6 dated 22.07.2OL6. Thereafter I Page 2 of 7 filed Writ Petition with Honourable High Court of Madras. Honourable High Court of Madras vide W.P.No. 345712021 dated 31.03.2021 directed the respondents to consider my case and pass appropriate orders within 30 days from the date of the said Court Order.
After protracted representations finally the joint Director of welfare, Namakkal-637001 sent a letter vide Na.ka.No. 5364/makul2$20 dated 06.09.2021 to the Divisional Manager, United India Insurance company Ltd, Divisional office O10600, 5th Floor, PLA Rathna Tower, 212, Anna salai, Chennai 600 006. In that letter the Joint Director recommended to reimburse the expenses incurred by me. It was also stated that the said recommendation was based on the High-Power Committee under the head of District Collector, Namakkal in view of the Honourable High Court of Madras's Directions.
Since no action was taken on the recommendation of the District Collector, an application was made by me to the CPIO, United India Insurance Company Ltd, Chennai on 21.Lt2O22.I was asked to send the Postal Order as the Court fee Stamp is not acceptable by the Deputy Manager vide letter RTI No. 240/2022-2023 dated
13.L2.2022. Thereafter I sent Postal order for Rs 10/- on L5.L2.2O22. As no reply was received, filed First Appeal to the First Appellate Authority under RTI on 05.04.2023.
The First Appellate Authority, Deputy General Manager, United India Insurance Co. Ltd, Chennai vide Ref No. W\/24L/2O23-2O24,A-35 dated 30.10.2023 rejected my request. The respected first Appellate Authority stated that the treatment taken in GKNM, Coimbatore is a covered procedure in a non network hospital as per the GO t71 dated 26/O62OL4. The NHIS 2014 Pensioners scheme is only on cashless basis and no reimbursement is allowed as mentioned in point No. 11(g) of GO 171 dated 261O6/2OL4 issued by Finance (Pension) Department.
In the mean time after protracted correspondences to the Government and Insurance Company I got an amount of Rs L,2O,O0O/'on 26.O7.2023 vide the letter Na.Ka No. 3591/2023 Aa 5 dated L7.O8.2O23 of the Treasury Officer, Namakkal.
Grounds of Appeal
1. The contention of the First Appellate Authority that treatment was taken in non-network hospital appears to be incorrect assessment of the facts of the case. When I was unconscious and in dire need of medical immediate attendance no one could expect to search for network covered hospital.
2. The Honourable High Court of Madras in the case of K.Srinivasan Vs State of Tamilnadu and Others in W.P.No. 13594 & 29192/2013 held that the-patient cannot be held to take treatment only in network hospital in medical emergency and directed to reimburse medical expenses with interest.Page 3 of 7
3. Similar view was held in the case of Raja Vs Secretary, Scheduled tribe welfares in W.P.No. 1408/2016dated 05.04.2016.
4. In my own case the Honourable High Court of Madras vide W.P.No. 34571202L directed to reimburse the medical expenses.
5. Since treatment was taken in non-network hospital cashless treatment is impossible. Further the High Court of madras has already ordered to reimburse my medical expenses. Further Joint director Welfare, Namakkal has already recommended my case to United India Insurance to reimburse medical expenses.
6. Further I was already granted reimbursement of an amount of Rs 1,2O,0OO/- on 26.07.2023 vide the letter Na.Ka No. 3591/2O23 Aa 5 dated 17.O8.2O23 of the Treasury Officer, Namakkal. Balance amount may also be granted.
In view of the above submissions suitable orders may be passed directing M/s United India Insurance Company Ltd to reimburse balance amount of medical expenditure to me. I shall remain grateful for thy kindness"
4. A written submission dated 31.07.2025 filed by Mrs. Chandra Srinivasan, CPIO is taken on record. Contents of the same are reproduced below:
"...1. Query dated 12/02/2024 to the CIC: Second Appeal was submitted and requested the justice to be rendered on the reimbursement of the medical expenditure incurred by I. Syed Rahiman.
REPLY FOR THIS APPEAL: The NHIS 2014 pensioners scheme is only on cashless basis and no reimbursement is allowed as per G.O 171 (In the First Appeal letter dated 03/04/2023 the date of illness is mentioned as during 13.11.2015). During that period as per G.O.171 no reimbursement allowed. Also UIICL is not the respondent in writ petition filed vide WP No:2457/2021, where the High Court of Madras itself directed only the Government to consider the reimbursement of the petitioner and not the UIICL. We herewith attached the writ petition for your reference."
Relevant Facts emerged during Hearing:
5. The following were present:-
Appellant: He, along with his authorized representative Shri S. Manoharan present through video conference.
Respondent: Shri P. M. Soundira Rajan, Manager-cum-APIO present through video conference.Page 4 of 7
6. Proof of having served a copy of Second Appeal on the Respondent while filing the same in CIC on 13.03.2024 is available on record. To a query from the Commission, the Appellant affirms service of the instant Second Appeal on the Respondent.
7. The Appellant's representative pleaded that the medical reimbursement of his treatment has not been done by the Respondent Public Authority till date despite repeated follow up and order of the Hon'ble High Court in his favour. He prayed the Commission to intervene in the matter.
8. On a query from the Commission, the Respondent initially failed to give proper submissions before the Bench enumerating the chain of events and facts of this case. He vaguely submitted that the NHIS 2014 pensioners scheme is only on cashless basis and no reimbursement is allowed as per G.O 171. Further, he was not a party to the writ petition, which the Appellant is referring to in his Appeal and no order has been given by the Hon'ble High Court to the United India Insurance Company Limited.
Decision:
9. The Commission, after adverting to the facts and circumstances of the case and perusal of the records, observes that as far as RTI Application is concerned, appropriate response has been provided to the Appellant earlier vide letter dated 30.10.2023 and now vide written submission dated 31.07.2025 by the Respondent, which are as the provisions of the RTI Act, and are thus, upheld. During the hearing, the Respondent categorically stated that there are no other documents on the subject in their records than what is already provided to the Appellant.
10. It is noteworthy that the CPIO is only a communicator of information based on the records held in the office and hence, he is not expected to create information as per the desire of the Appellant.
11. It was noted during the hearing that the Appellant is embracing his grievance regarding non-reimbursement of his medical claim, and no specific information has been sought by him as per Section 2(f) of the RTI Act. In this regard, attention of the Appellant is drawn towards certain precedents of the superior Courts as under:
Page 5 of 712. The Hon'ble High Court of Delhi in the matter of Hansi Rawat and Anr. v. Punjab National Bank and Ors. (LPA No.785/2012) dated 11.01.2013 has held as under:
"6. ....proceedings under the RTI Act cannot be converted into proceedings for adjudication of disputes as to the correctness of the information furnished."(Emphasis Supplied)
13. The aforesaid rationale finds resonance in another judgment of the Hon'ble Delhi High Court in the matter of Govt. of NCT of Delhi vs. Rajender Prasad (W.P.[C] 10676/2016) dated 30.11.2017 wherein it was held as under:
"6. The CIC has been constituted under Section 12 of the Act and the powers of CIC are delineated under the Act. The CIC being a statutory body has to act strictly within the confines of the Act and is neither required to nor has the jurisdiction to examine any other controversy or disputes."
14. While, the Apex Court in the matter of Union of India vs Namit Sharma (Review Petition [C] No.2309 of 2012) dated 03.09.2013 observed as under:
"20. ...While deciding whether a citizen should or should not get a particular information "which is held by or under the control of any public authority", the Information Commission does not decide a dispute between two or more parties concerning their legal rights other than their right to get information in possession of a public authority...."
(Emphasis Supplied)
15. In view of the above, no relief can be granted in the matter.
16. However, in the spirit of the RTI Act, the Respondent is directed to share a copy of her written submission dated 31.07.2025 along with enclosures free of charge with the Appellant within one week of the date of receipt of this order and a compliance report of the same be uploaded through the link given in the CIC's hearing notice, immediately thereafter.
17. Notwithstanding the aforesaid, the Commission adversely viewed the conduct of Shri P. M. Soundira Rajan, who was not well acquainted with the facts of the instant case and failed to assist the Bench during hearing. He is Page 6 of 7 cautioned to be careful and ensure that such lapses should not be repeated in future.
The appeal is disposed of accordingly.
Vinod Kumar Tiwari (िवनोद कुमार ितवारी) Information Commissioner (सूचना आयु ) Authenticated true copy (अिभ मािणत स!ािपत ित) (S. Anantharaman) Dy. Registrar 011- 26181927 Date Copy To:
The FAA United India Insurance Co. Ltd., Regional Office, 134, Silingi Buildings, Greams Road, Chennai - 600006 Page 7 of 7 Recomendation(s) to PA under section 25(5) of the RTI Act, 2005:-
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