Date: 16.06.

2021

From

P.GURUNATHAN,
‘Thayarul’, Door No.106,
Plot No.22, I Main Road,
Rajeswari Nagar,
Aranvoyal Kuppam,
TIRUVALLUR,
PIN: 602 025.

To

The Commissioner of Treasuries and Accounts,

Pension Pay Office, Saidapet, Chennai 600035

Sir,

Sub: HEALTH INSURANCE - P.Gurunathan, Pensioner, Retired Asst.Commr., Revenue

Administration, Chepauk, Chennai.5 – Date of Retirement: 31.3.2017 – Suffered
By COVID 19 – Insurance amount Rs.1,33,446/- claimed – Reg.

Ref: 1. Office of the Accountant General (A&E) Tamil Nadu, Chennai 600 018
No.PO1/10116031/2/PPO NO.R0116031, dt.18.04.2017.
2. Appasamy Hospitals, Arumbakkam, Chennai 106, Proposals dt.12.5.2021
addressed to Insurance Company.
3. Discharge Summary dated 19.05.2021.
4. Maruti Scans & Labs Tiruvallur dt.9.5.2021.
5. Appasamy Hospitals, Arumbakkam, Chennai 106 Test reports dt.10.5.21 &
11.5.2021.
6. Appasamy Hospitals, Arumbakkam, Chennai 106 Final Bill Dt.19.5.2021.
7. Appasamy Hospitals, Arumbakkam, Chennai 106 Pharmacy Bills. (20 Nos.
as Index.

*****

I submit my application for sanction of Health Insurance Reimbursement amount of

Rs. 1,33,446/- (Rupees One lakh thirty three thousand four hundred and forty six only).

2. I served as Assistant Commissioner in the Office of the Commissioner of Revenue

Administration, Chepauk, Chennai.5 and retired on 31.03.2017. I am a State Government
Pensioner. A sum of Rs.350/- is being recovered from my Pension towards medical
reimbursement.
 -2-

3. On 09.05.2021, I was affected by COVID 19 and admitted in Appasamy Hospitals,

Arumbakkam, Chennai 106 from 10.05.2021 to 19.05.2021. I underwent medical treatment
there. The Hospital sent proposal for Rs.1,60,000/- (Rupees One Lakh Sixty thousand only)
to Insurance Company on 12.05.2021. On 19.05.2021, up to 4.00 P.M. no amount was
received from Insurance Company.

4. With much difficulty, I paid Rs.1,33,446/- (Rupees One lakh thirty three thousand
four hundred and forty six only) towards Medical Treatment. I request you, the amount of
Rs. 1,33,446/-may kindly be sanctioned and paid to me. I have enclosed herewith the
Medical Bills and Discharge Summary in original and the Xerox copies of the Authorisation
for Pension & CVP – Pensioner Half, Health Insurance Card, Aadhaar Card and Test reports.

Thanking you, Sir,

Yours faithfully,

(P.GURUNATHAN)

Encl.: As stated above.