Warn every network hospital under the insurance scheme against demanding money for admission or treatment
under the cashless scheme

Government servants, who had not adhered to the terms of the insurance agreement, could seek relief directly from the government
under the Tamil Nadu Medical Attendance Rules

MADURAI: The Madras High Court Bench here on Friday held that Star Health and Allied Insurance, a private company engaged by the State government for providing health insurance to its employees, was not bound to settle claims made by beneficiaries who had either undergone medical procedures that were not covered under the scheme or obtained treatment at non-network hospitals. 
Allowing a writ appeal filed by the company challenging a single judge’s order, a Division Bench, comprising Justice Prabha Sridevan and Justice B. Rajendran, held that the appellant was strictly bound by the terms of contract and could not be asked to indemnify claims which did not fall within those terms.
Disposing of a batch of 15 writ petitions filed by government servants along with the writ appeal, the Bench held that the insurer was also not liable to reimburse those who had paid from their pockets because the insurance scheme was a cashless facility whereby the insurance company paid directly to the hospitals concerned. Writing the judgment, Ms. Justice Sridevan said: “The relationship of the insurance company with the claimant is purely contractual… 
The company cannot pay cash and if we issue direction to the insurance company to reimburse the claim, we would be virtually re-writing the contract which we are not entitled to.”However, the judges pointed out those government servants, who had not adhered to the terms of the insurance agreement, could seek relief directly from the government under the Tamil Nadu Medical Attendance Rules.
The government was directed to issue necessary orders making it clear that if for some satisfactory reason, a claimant was unable to take treatment in a network hospital but had been advised or had to go to a non-network hospital, then his claim would be considered under the Tamil Nadu Medical Attendant Rules.
Further, the government was ordered to warn every network hospital under the insurance scheme against demanding money for admission or treatment under the cashless scheme. 
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