P.Gopinathan v. The Secretary To Government

BEFORE THE MADURAI BENCH OF MADRAS HIGH COURT DATED : 17.08.2022

CORAM

THE HONOURABLE MR. JUSTICE M.S.RAMESH P.Gopinathan ... Petitioner /Vs./ 1.The Secretary to Government, Secretariat, Fort St.George, Chennai.

2.The Director of Treasuries and Accounts, Panagal Buildings, Saidapet, Chennai - 600 015.

3.The United India Insurance Co. Ltd., Represented by its Divisional Manager, Divisional Office VI, 5th Floor, P.L.A.Rathana Towers, No.212, Anna Salai, Chennai - 6.

4.District Level Committee, Represented by Collector, At Nagercoil, Kanyakumari District.

5.The District Treasury Officer, District Treasury Office, Nagercoil, Kanyakumari District.

6.The Joint Director of Medical and Rural Health Service, At Nagercoil, Kanyakumari District.

...Respondents

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PRAYER: Writ Petition filed under Article 226 of the Constitution of India, praying this Court to issue a Writ of Mandamus, directing the respondents to disburse a sum of Rs.2,35,771/- to the petitioner for the treatment underwent by him along with interest at the rate of 18 percent per annum by considering the application dated 03-08-2017 within a stipulated time fixed by this Court. For Petitioner : Mr.S.C.Herold Singh For Respondents : Mr.A.Sivanupandian Additional Government Pleader (for R1, R2 & R4 to R6) : Mr.A.Shajahan (for R3)

ORDER

The petitioner herein, who is the pensioner and a member of the New Health Insurance Scheme, which introduced for Government Employees and Pensioners, claims medical reimbursement for a sum of Rs.2,35,771/- for the treatment underwent by him, at Kerala Institute of Medical Science, Trivandrum, for Cardiac Surgery.

2.In the counter affidavit filed by the fifth respondent, it is stated that the petitioner's claim for medical reimbursement was referred to the District Level Empowered Committee (hereinafter referred to as "DLEC" for brevity), which 2/6

is the Committee constituted by the Government headed by the District Collector, having the Joint Director of Medical and Rural Health Services Department, the District Treasury Officer and an official representative of the Insurance Company as members and it was rejected by the DLEC, stating that the petitioner had not taken treatment in a network hospital. 3.The issue as to whether the medical reimbursement can be rejected on the ground that the treatment was not taken in network hospital or that the ailment/treatment/surgery was not scheduled one, has already been dealt with in various decisions of this Court, whereby it has been held that such rejection on the ground of non-network hospital or non-scheduled ailment/treatment/surgery cannot be a ground for rejection.

4.The next question that arises for consideration is that who would be liable to reimburse the medi-claim raised by the petitioner herein. The Government, in G.O.Ms.No.423, Health and Family Welfare (Z1) Department, 22.06.1995 had ordered that whenever the hospital is not covered or the treatment is not enlisted under the New Health Insurance Scheme, the Government Employees and the pensioners would be entitled to make the mediclaim with the Government under the Tamil Nadu Medical Attendance Rules 3/6

(hereinafter referred to as "the Rules" for brevity) for reimbursement. The rates fixed by the Government under the Rules have also been revised subsequently in G.O.Ms.No.401, Health and Family Welfare (Z1) Department, dated 09.09.2021, by making a reference to their liability, under G.O.Ms.No.423, Health and Family Welfare (Z1) Department, dated 22.06.1995. 5.Thus, when the ailment/treatment/surgery undertaken by the Government Employees and Pensioners either not in one of the network hospitals or it is not scheduled one, the State Government would be liable to reimburse the eligible claim of such Government Employees and Pensioners, in accordance with the rates prescribed under the Rules. 6.In the light of the aforesaid Government Orders, DLEC ought to have held that the Government Employee / Pensioner would be entitled for reimbursement from the State Government, in accordance with the rates prescribed under the Rules.

7.Accordingly, there shall be a direction to the respondents 1, 2, & 4 to 6, to reimburse the eligible amount for the medical expenses incurred for the treatment undergone by the petitioner, within a period of four (4) weeks from 4/6

the date of receipt of a copy of this order. This Writ Petition is allowed accordingly. There shall be no order as to costs. 17.08.2022 Index : Yes / No Internet : Yes/ No sm To:

1.The Secretary to Government, Secretariat, Fort St.George, Chennai.

2.The Director of Treasuries and Accounts, Panagal Buildings, Saidapet, Chennai - 600 015.

3.The District Level Committee, Represented by Collector, At Nagercoil, Kanyakumari District.

4.The District Treasury Officer, District Treasury Office, Nagercoil, Kanyakumari District.

5.The Joint Director of Medical and Rural Health Service, At Nagercoil, Kanyakumari District.

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M.S.RAMESH , J.

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