Velu v. The Director Of Medical And Rural Health Service

IN THE HIGH COURT OF JUDICATURE AT MADRAS

DATED : 29.07.2024

CORAM

THE HONOURABLE MR. JUSTICE G.K.ILANTHIRAIYAN Velu ... Petitioner Vs

1. The Director of Medical and Rural Health Service, Directorate, Anna Salai, Theynampet, Chennai.

2. The Deputy Director of Medical and Rural Health Service and Family Welfare, District Family Welfare Bureau, Taluk Office, Vellore District.

3. The District Level Empowered Committee headed by the District Collector, Vellore District.

4. The District Collector, Tirupattur District.

5. The Treasury Officer, Sub-Treasury, Tirupattur.

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6. The Superintendent of Police, Tirupattur District.

7. The Branch Manager, United India Insurance Co. Limited, Regional Office - Silingi Buildings, 134, Greams Road, Chennai - 600 006.

8. The Branch Manager, MD India Health Insurance TPA Private Limited, Raheja Towers, Unit # 005, Delta Wing, #177, Ground Floor, Mount Road, Anna Salai, Chennai - 600 002.

... Respondents Writ Petition is filed under Article 226 of the Constitution of India praying to issue a Writ of Mandamus, directing the respondents to pay the balance medical bill of Rs. 2,70,970/- to the petitioner payable under New Health Insurance Scheme 2022 for reimbursing Medical Expenditure incurred by the petitioner towards his treatment on 04.11.2023 with the interest at the rate of 12%.

For Petitioner : Mr. M.Arun For Respondents : Mr. M.Bindran, Additional Government Pleader (for R1 & R2) Mr. S.Arumugam, Government Advocate (for R3 to R6) 2/7

O R D E R

This Writ Petition is filed for directing the respondents to pay the balance medical bill of Rs. 2,70,970/- payable under the New Health Insurance Scheme 2022, for reimbursing Medical Expenditure incurred by the petitioner towards his treatment on 04.11.2023, with the interest at the rate of 12%.

2. The petitioner had worked as a Sub-Inspector of Police in the Tamil Nadu Police Department. After his retirement, the Government of Tamil Nadu introduced a New Health Insurance Scheme for the welfare of State Government Employees and their family members. The petitioner was issued an insurance policy and identity card, as well as his family members. The petitioner was admitted as an inpatient at NH Narayana Institute of Cardiac Sciences Hospital in Bangalore, complaining of chest pain, and was diagnosed with Coronary Artery Disease and Acute Coronary Syndrome. Therefore, the petitioner underwent Angiogram treatment and spent a sum of Rs.4,08,970/- as medical expenditure. The petitioner made a reimbursement claim under the medical scheme and was paid only a sum of Rs.1,38,000/-. Therefore, the petitioner submitted a representation to consider the 3/7

remaining amount spent by him.

3. Similar matters came up before this Court, and this Court issued directions to the District Level Empowered Committee to ascertain the medical expenses incurred by the employee.

4. Considering the above facts and circumstances of this case, the petitioner is at liberty to submit a fresh representation before the District Level Empowered Committee. On receipt of the same, the District Level Empowered Committee is directed to consider it and pass orders on merits and in accordance with law within a period of four weeks thereafter.

5. With the above directions, this Writ Petition is disposed of. No costs.

29.07.2024 Index:Yes/No kv To 4/7

1. The Director of Medical and Rural Health Service, Directorate, Anna Salai, Theynampet, Chennai.

2. The Deputy Director of Medical and Rural Health Service and Family Welfare, District Family Welfare Bureau, Taluk Office, Vellore District.

3. The District Level Empowered Committee headed by the District Collector, Vellore District.

4. The District Collector, Tirupattur District.

5. The Treasury Officer, Sub-Treasury, Tirupattur.

6. The Superintendent of Police, Tirupattur District.

7. The Branch Manager, United India Insurance Co. Limited, Regional Office - Silingi Buildings, 134, Greams Road, Chennai - 600 006.

8. The Branch Manager, MD India Health Insurance TPA Private Limited, 5/7

Raheja Towers, Unit # 005, Delta Wing, #177, Ground Floor, Mount Road, Anna Salai, Chennai - 600 002.

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G.K.ILANTHIRAIYAN, J.

kv 29.07.2024 7/7