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Madras High CourtWP(MD)/23218/2016disposed of

P.Indra Devi, v. The Govt. Of Tamilnadu,

2016-12-02Honourable Dr. Justice S. Vimala3 pages

BEFORE THE MADURAI BENCH OF MADRAS HIGH COURT DATED : 02.12.2016 CORAM :

THE HONOURABLE DR.JUSTICE S.VIMALA W.P(MD)No.23218 of 2016 and W.M.P(MD)No.16657 of 2016 P.Indra Devi ... Petitioner vs.

1)The Government of Tamilnadu, Rep. by its Secretary, Fort St.George, Chennai-600 009.

2)District Collector, Sivagangai District, Sivagangai.

3)The Joint Director, Medical and Rural Health Services Department, Sivagangai District Head Quarters, Sivagangai District.

4)The Treasury Officer, District Treasury, Sivagangai.

5)MD Indian Health Care Services (TPA) Private Ltd., (Unit of United India Insurance Company Ltd., Rep. through its Assistant Manager, No.27, Lakshmi Towers, 3rd Floor, Dr.Radhakrishnan Salai, Mylapore, Chennai-600 004.

... Respondents Petition filed under Article 226 of the Constitution of India, praying for the issuance of a Writ of Certiorarified Mandamus, calling for the records relating to the impugned orders passed by the 5th respondent dated Nil received by the petitioner on 10.08.2016 and quash the same and consequently direct the respondents to reimburse a sum of Rs.1,06,602/- to the petitioner towards the medical expenses incurred by the petitioner for the petitioner's husband's medical treatment between 06.08.2016 and 18.08.2016 at Gunasundari Bose Hospital, Madurai, within a time stipulated by this Hon'ble Court.

For Petitioner : Mr.G.Mohankumar For R1 to R4 : Mr.V.R.Shanmuganathan Special Government Pleader For R5 : Mr.A.Shajahan

ORDER

This Writ of Certiorarified Mandamus has been filed, calling for the records relating to the impugned order passed by the 5th respondent rejecting the request of the petitioner for reimbursement under the New Health Insurance Scheme and to quash the same and consequently to direct the respondents to reimburse a sum of Rs.1,06,602/- to the petitioner towards the medical expenses incurred by the petitioner towards her husband's medical treatment between 06.08.2016 and 18.08.2016 at Gunasundari Bose Hospital, Madurai.

2.The petitioner is working as a Secondary Grade Teacher at Thirupuvanam Panchayat Union Primary School. The petitioner and her family members are covered by the Government of Tamil Nadu New Health Insurance Scheme. The petitioner's husband suffered acute stomach pain and it was diagnosed as Ileoilea Intussusception due to polys. He was admitted in an unscheduled hospital and immediately, Lapartomy surgery was performed at 09.00 a.m on 06.08.2016. The petitioner incurred expenditure of Rs.1,06,604/- towards the treatment of her husband. She made a representation through mail to the 5th respondent on 09.08.2016, claiming reimbursement of the abovesaid amount. But, the 5th respondent on 10.08.

2016 replied through mail, rejecting the request of the petitioner for reimbursement under the New Health Insurance Scheme, stating that the petitioner's husband took treatment in the hospital, which is not a scheduled one under the Insurance Scheme. Aggrieved by the rejection, the petitioner made a detailed representation dated 12.09.2016 to the 2nd respondent, through proper channel. After examination of the medical records, the petitioner was directed to appear before the committee headed by the 2nd respondent/District Collector, Sivagangai, on 25.11.2016. On the said date, she was orally informed that her claim is rejected, as the treatment was taken in the unscheduled hospital. Hence, this writ petition. 3.

The issue regarding eligibility for reimbursement when treatment is taken in an unapproved hospital is no more res integra and it is governed by the decision reported in 2016 (3) CTC 394 in the case of N.Raja vs. The Government of Tamil Nadu.

remittance of the amount to the Hospital by the petitioner to till the date of payment.

4. It is not in dispute that facts and circumstances of the present case are also similar to the abovesaid decision and therefore, the said decision squarely applies to this case also. 5.In the light of the decision in N.Raja's case(supra), the impugned order is set aside and the respondents are directed to sanction and reimburse the medical expenses of Rs.1,06,604/ incurred by the petitioner for the treatment of her husband with 9% interest, from the date of remittance of the amount to the Hospital by the petitioner to till the date of payment, within a period of four weeks from the date of receipt of a copy of this order.

With the above direction, this Writ Petition stands allowed. No costs. Consequently, WMP(MD)No.16657 of 2016 is closed. Sd/ Assistant Registrar(CS-I) /True Copy/ Sub Assistant Registrar.

To 1)The Secretary,Government of Tamilnadu,Fort St.George, Chennai-600 009.

2)District Collector,Sivagangai District,Sivagangai. 3)The Joint Director,Medical and Rural Health Services Department, Sivagangai District Head Quarters,Sivagangai District. 4)The Treasury Officer,District Treasury, Sivagangai. 5)The Assistant Manager, Indian Health Care Services (TPA) Private Ltd.,(Unit of United India Insurance Company Ltd.,No.27, Lakshmi Towers, 3rd Floor, Dr.Radhakrishnan Salai, Mylapore, Chennai-600 004.

+1CC to M/S.A.Shajahan,Advocate, SR.No. 79101 +1CC to M/S.G.Mohan Kumar, Advocate, SR.No. 79066 +1CC to the Special Government Pleader, SR.No. 79477 W.P(MD)No.23218 of 2016 02.12.2016 nbi AM/SS3/19.01.2017/3P/9C