P.Alagarsamy, v. The Government Of Tamil Nadu

BEFORE THE MADURAI BENCH OF MADRAS HIGH COURT DATED: 18.12.2020

CORAM:

THE HONOURABLE MR.JUSTICE KRISHNAN RAMASAMY W.P (MD)No.10440 of 2017 P.Alagarsamy ... Petitioner Vs.

1.The Government of Tamil Nadu, Represented by its Secretary, Fort St.George, Chennai.

2.The District Collector, Virudhunagar District.

3.M.D.Indian Health Care Services, (TPA) Private Limited, (Unit of United India Insurance Company Limited), No.27, Lakshmi Towers 3rd Floor, Dr.Radhakrishnan Salai, Mylapore, Chennai-600 004.

4.The Joint Director, Medical & Rural Health Services and Family Welfare, Virudhunagar.

... Respondents Prayer: Writ Petition is filed under Article 226 of the Constitution of India for issuance of a Writ of Certiorarified Mandamus to call for the records in pertaining to the order of the second respondent in K.1/26314/2016 dated 26.09.2016 and quash the same and issue the direction to the third respondent to give the Medical reimbursement amount of Rs.3,08,511/-.

For Petitioner : Mr.S.Balaji For R-1, R-2 and R-4 : Mr.K.P.Narayanakumar Special Government Pleader Mr.A.Shajahan for R3.

O R D E R

This writ petition has been filed challenging the impugned order passed by the second respondent in K.1/26314/2016 dated 26.09.2016 whereby the second respondent rejected the claim of the petitioner for reimbursement of the medical expenses of Rs.3,08,511/- on the ground the treatment was taken in non network hospital.

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2.The learned counsel appearing for the petitioner would submit that the petitioner has taken a treatment in non network hospital, which is an urgent requirement. This aspect was not considered by the respondents, while passing the impugned order. That apart, he has taken treatment from professionally qualified Doctor in the hospital and the amount spent by the petitioner is also reasonable. Therefore, he is entitled for medical reimbursement. 3.The learned Special Government Pleader appearing for the respondents 1, 2 and 4 would submit that in a batch of writ petition in W.P.(MD).Nos.21950 of 2016 etc., dated 16.12.2020, this Court has passed a detailed order with regard to the treatment taken in non network hospital how it should be treated and how it should be decided and on the same line, the order may be passed.

4. Heard the learned counsel for the petitioner and the learned Special Government Pleader appearing for the respondents 1, 2 and 4 and perused the materials available on record. 5.This Court has already passed an order in a batch of writ petitions in W.P.(MD).Nos.21950 of 2016 etc., dated 16.12.2020 wherever the treatment has taken in a non network hospital, the District Level Empowered Committee should pass a detailed order by taking into consideration of the necessity of the medical expense and emergency situation and that apart, the reasonable amount spent for medical expenses and the treatment provided by the qualified medical practitioner.

These aspects should be considered for reimbursement of the medical claim and the respondents should not reject the claim in a mechanical manner stating that the treatment has been taken in non-net work hospital. On perusal of the impugned order, it appears that all the above aspects have not been considered by the second respondent, while passing the order. 6.In view of the above observations, this Writ Petition is allowed and impugned order passed by the second respondent in K.1/26314/2016 dated 26.09.2016 is set aside and the matter is remanded back to the second respondent, who in turn shall send the particulars to the District Level Empowered Committee for fresh consideration, to pass necessary orders in the light of the order passed by this Court in W.P.(MD).Nos.21950 of 2016 etc., dated 16.12.2020.

Sd/- Assistant Registrar () // True Copy // / /2021 Sub Assistant Registrar(CS) 2/3

cp Note:

In view of the present lock down owing to COVID-19 pandemic, a web copy of the order may be utilized for official purposes, but, ensuring that the copy of the order that is presented is the correct copy, shall be the responsibility of the advocate/litigant concerned.

To 1.The Secretary, The Government of Tamil Nadu, Fort St.George, Chennai.

2.The District Collector, Virudhunagar District.

3.The Joint Director, Medical & Rural Health Services and Family Welfare, Virudhunagar.

+1CC to M/s.SPL GP,SR.No.26851 dated 22/12/2020 +1CC to A.Shajahan,Advocate,SR.No.26419 dated 21/12/2020 W.P (MD)No.10440 of 2017 18.12.2020 ES(CO) KB(18.01.2021) 3P 6C 3/3