I.Yesudhas(Died) v. State Of Tamil Nadu

BEFORE THE MADURAI BENCH OF MADRAS HIGH COURT DATED : 25.08.2025

CORAM

THE HONOURABLE MR.JUSTICE G.R.SWAMINATHAN and THE HONOURABLE MR.JUSTICE K.RAJASEKAR 1.I.Yesudhas (Died) (Cause title is amended vide order dated 25.08.2025 in W.P.(MD)No.5015 of 2015 by GRSJ & KRSJ).

2.Y.A.Shini ... Appellants Vs.

1.State of Tamil Nadu, Rep. by the Secretary to Government, School Education Department, Secretariat, Fort St. George, Chennai.

2.The District Educational Officer, Office of the District Educational Officer, Kuzhithurai, Marthandam P.O., Kanyakumari District.

3.The Chief Educational Officer, Office of the Chief Educational Officer, At Nagercoil, Kanyakumari District.

4.The Joint Director, Medical and Rural Health Services, 1/8

Medical and Rural Development, At Nagercoil.

5.The United India Insurance Company Ltd., Third Party Administration, The New Health Insurance Scheme 2012 of Government of Tamil Nadu, Chennai.

...Respondents

PRAYER: Writ Appeal is filed under Clause 15 of the Letters Patent Act, to allow the appeal and set aside the order of the learned Judge of this Court in W.P.(MD)No.5090 of 2015 dated 27.02.2017. For Appellants : Mr.S.Titus For Respondents : Mr.C.Venkateshkumar, Spl. Government Pleader for R1 to R4.

Mr.A.Shajahan for R5

JUDGMENT

(By G.R.SWAMINATHAN, J.) Heard both sides.

2.The unsuccessful writ petitioners are the appellants herein. They are none other than the husband and daughter of one Alphonse. She was working as a School Teacher. She suffered a health breakdown while in harness in the year 2012. She had to be admitted to hospital and the cost 2/8

of medical treatment was around Rs.25,00,000/-. She also passed away on 23.08.2015. Since she was covered by the New Health Insurance Scheme, 2012 floated by the government, the writ petitioners sought medical reimbursement. The request was rejected by the fourth respondent vide proceedings dated 21.03.2013 and 24.02.2015. Challenging the same, W.P.(MD)No.5090 of 2015 was filed. The learned Single Judge disposed of the writ petition on 27.02.2017 in the following terms:- "9.Accordingly, this writ petition is allowed and the impugned order dated 04.10.2016 is hereby set aside. The concerned respondent, namely, the 1st respondent is directed to sanction the medical expenses incurred by the petitioner/employee/petitioner, as per the eligibility criteria in terms of the amount under the Scheme along with interest @ 9% p.a.

without standing on technicalities and release the eligible amount within a period of two months from the date of receipt of a copy of this order." Aggrieved by the same, this writ appeal has been filed. 3.

not so. The learned Single Judge stated that the writ petitioners should be paid as per the terms of the scheme. The learned Single Judge had given such a direction because the appellants were not paid even a single paisa towards reimbursement. It is seen that Alphonse suffered health breakdown on 14.09.2012 and was admitted in Kims Hospital, Trivandrum on the said date. It is true that Kims Hospital, Trivandrum is not a network hospital. Therefore, the insurance company was probably justified in declining to pay the cost of treatment incurred in the said non-network hospital. However, Alphonse was discharged from Kims Hospital subsequently and had taken treatment mostly in Kanaykumari Medical Mission C.S.I Hospital, Marthandam. It appears that very substantial amount was paid by the appellants only to the said hospital.

The said hospital appears to be a network hospital. 4.We, therefore, permit the second appellant to submit a fresh application to the fifth respondent setting out all the details and enclosing all the relevant materials.

to the tune of Rs.4,00,000/- shall be paid by the fifth respondent. In any event, the fifth respondent shall pass a speaking order on the application to be submitted by the second appellant within a period of eight weeks thereafter. If the second appellant is still aggrieved by the same, it is open to the second appellant to file an appeal before first respondent. The government shall also consider the case of the second appellant as per Tamil Nadu Medical Attendance Rules.

5.This writ appeal is disposed of accordingly. No costs. (G.R.S. J.,) & (K.R.S. J.,) 25.08.2025 NCC : Yes/No Index : Yes / No Internet : Yes/ No ias 5/8

To:

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

2.The District Educational Officer, Office of the District Educational Officer, Kuzhithurai, Marthandam P.O., Kanyakumari District.

3.The Chief Educational Officer, Office of the Chief Educational Officer, At Nagercoil, Kanyakumari District.

4.The Joint Director, Medical and Rural Health Services, Medical and Rural Development, At Nagercoil.

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G.R.SWAMINATHAN, J.

and K.RAJASEKAR, J.

ias 25.08.2025 (3/3) 8/8