ESI's Refusal To Reimburse Medical Expenses On Minor Technical Grounds Arbitrary: Kerala HC
6 days, 23 hours ago

ESI's Refusal To Reimburse Medical Expenses On Minor Technical Grounds Arbitrary: Kerala HC

Live Law  

Kerala High Court: A Single Judge Bench of Honourable Mr. Justice C.S. The court held that ESIC's refusal to reimburse expenses for an emergency liver transplantation on grounds such as non-submission of an 'emergency certificate' was hyper-technical and arbitrary. Background Mrs. Suma Sunilkumar, insured under the ESIC scheme, sought reimbursement for her husband's emergency liver transplantation expenses. He submitted that the surgery had been approved by the ESIC's Technical Committee, and all requested documents, including the emergency certificate, were eventually provided. Further, the court ruled that the emergency certificate confirmed the patient's critical condition, who had a high risk of death without immediate surgery.

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History of this topic

ESI | Medical Reimbursement Can't Be Denied Merely Because Insured Person Got Treated At Hospital Not Approved By Insurer: Kerala HC Reaffirms
2 weeks, 6 days ago

ESI | Medical Reimbursement Can't Be Denied Merely Because Insured Person Got Treated At Hospital Not Approved By Insurer: Kerala HC Reaffirms

Live Law  

The Kerala High Court on Thursday reiterated that medical reimbursement cannot be denied because an insured underwent treatment in a hospital not approved by the insurer. The petitioner sought reimbursement from the Employees State Insurance Corporation, since her husband had to undergo an emergency liver transplantation in a non ESIC hospital. Justice C S Dias ordered for reimbursement and held …

'Rules Condone A Situation Where Patient Avails Emergency Treatment In Non-Empanelled Hospital': Kerala HC On Reimbursement Claim In Liver Transplant Case
2 years, 2 months ago

'Rules Condone A Situation Where Patient Avails Emergency Treatment In Non-Empanelled Hospital': Kerala HC On Reimbursement Claim In Liver Transplant Case

Live Law  

The Kerala High Court recently directed the state government to reconsider its decision in a case where an application for reimbursement was rejected because Apollo Hospital, where the patient had gone for treatment in 2011, was a non-recognized hospital under the Medical Reimbursement Scheme and no prior permission had been obtained for availing the treatment there.Justice Devan. The Kerala High …

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