Kerala High Court
Sajan T Sunny vs The State Of Kerala on 16 November, 2023
IN THE HIGH COURT OF KERALA AT ERNAKULAM
PRESENT
THE HONOURABLE MR. JUSTICE RAJA VIJAYARAGHAVAN V
THURSDAY, THE 16TH DAY OF NOVEMBER 2023 / 25TH KARTHIKA, 1945
WP(C) NO. 29689 OF 2023
PETITIONER:
SAJAN T SUNNY, AGED 63 YEARS, S/O. SRI. C.T.XAVIER,
SASTHAMPADIKKAL HOUSE, OLASSA P.O, KOTTAYAM,
PIN - 686014.
BY ADVS.
AJIV DEV
ALAN PRIYADARSHI DEV
S.SAJEEVAN
RESPONDENTS:
1 THE STATE OF KERALA, REPRESENTED BY CHIEF SECRETARY,
ROOM NO. 202, NORTH SANDWICH BLOCK, SECRETARIAT,
THIRUVANANTHAPURAM, PIN - 695001.
2 THE SECRETARY TO GOVERNMENT OF KERALA,
HEALTH & FAMILY WELFARE, SECRETARIAT ANNEXE, 2,
THIRUVANANTHAPURAM, PIN - 695001.
3 DIRECTOR OF HEALTH SERVICES, KERALA,NEAR GENERAL
HOSPITAL ROAD, JUNCTION, THIRUVANANTHAPURAM,
PIN - 695035.
4 THE ORIENTAL INSURANCE COMPANY LTD,METRO PALACE,
XAVIER ARAKKAL RD, OPPOSITE TOWN RAILWAY STATION,
ERNAKULAM NORTH, KACHERIPADY, KOCHI, ERNAKULAM,
KERALA 682018, REPRESENTED BY ITS REGIONAL MANAGER.
5 THE PROJECT HEAD, MEDISEP,THE ORIENTAL INSURANCE
COMPANY LTD, YWCA BUILDING, M.G. ROAD,
THIRUVANANTHAPURAM, PIN - 695001.
6 ASTER MEDCITY HOSPITAL, KUTTISAHIB ROAD
CHERANELLOOR, SOUTH CHITTOOR, KOCHI, KERALA - 682027
REPRESENTED BY ITS CHAIRMAN.
W.P. (C) No.29689 of 2023 2
*ADDL R7 THE DISTRICT LEVEL GRIEVANCE REDRESSAL COMMITTEE
REPRESENTED BY ITS CONVENOR, THE DISTRICT
COLLECTOR.
*ADDL R7 IS SUO MOTU IMPLEADED AS ADDITIONAL
RESPONDENT AS PER ORDER DATED 16.11.2023 IN WPC
NO.29689 OF 2023.
SRI. GEORGE A CHERIAN, SC FOR THE ORIENTAL INSURANCE
COMPANY
THIS WRIT PETITION (CIVIL) HAVING COME UP FOR ADMISSION ON
16.11.2023, THE COURT ON THE SAME DAY DELIVERED THE FOLLOWING:
W.P. (C) No.29689 of 2023 3
JUDGMENT
The petitioner states that he has retired from the Commercial
Taxes Department and is a service pensioner. While he was in service, he
was enrolled in the MEDISEP scheme. He asserts that he had paid a
monthly premium of Rs.500/- and he got included. He states that he was
diagnosed with Parkinson's disease and has been under the treatment for
the same at Sree Chithira Thirunal Institute for Medical Science and
Technology, Thiruvananthapuram. He was advised to undergo Deep Brain
Stimulation Surgery to control the disease. He states that he sought a
second opinion from Aster Medicity, Ernakulam and had to undergo
surgery. As per the estimate, the amount for surgery would come to about
Rs.10,30,000/-. In order to avail of the procedure of a cashless facility, the
petitioner contacted the Oriental Insurance Company, the 4th respondent.
However, he was informed that the hospital chosen by him has not been
empanelled in the network hospitals of MEDISEP and the claim cannot be
considered. He states that, being aggrieved he registered a complaint
before the grievance cell. Immediately thereafter in terms of the
provisions of Ext.P9, which provides for grievance redressal, he preferred
Ext.P6 complaint before the District Authority. The grievance of the
petitioner is that no action has been taken.
2. When the matter was taken up for consideration on
16.10.2023, the petitioner had submitted before this Court that he is not
pressing relief No.4.
3. When the matter is taken up today, the learned Standing
Counsel appearing for the 4th respondent submitted that in response to
Ext.P4, a mail was issued by the respondents informing the petitioner that
Aster Medicity, Kochi is not in the list of hospitals which are empanelled
with MEDISEP. The learned counsel further submits that, as per Clause
19 of Ext. P9, a District Level Grievance Redressal Committee has been
established as the lowest level authority, with a State Level Grievance
Redressal Committee and an Appellate Authority empowered to make final
decisions on orders issued by lower authorities. The learned counsel
submits that the records disclose that the petitioner has already
approached the District Level Grievance Redressal Authority as is borne out
from Ext.P6. The learned counsel submits that it would be in the fitness of
things to direct the District Level Grievance Redressal Committee, which
comprises of the District Collector, Representative Convener, The District
Medical Officer, the representative of the Insurer and the Finance Officer of
the District Collectorate to hear the matter as expeditiously as possible.
4. The learned Government Pleader points out that as per
Ext.P9, the Committee has been ordered to resolve the grievance within
thirty days from the date of receiving the application. It is stated that if
the petitioner is not satisfied, he can always approach the State Level
Committee.
5. I have considered the submissions advanced and have
gone through the records. The grievance of the petitioner essentially
concerns the non-empanelment of the 6th respondent hospital in MEDISEP
and also to treat the ailment suffered by the petitioner under the specified
category. The records disclose that the petitioner has preferred a
complaint before the District Level Authority, which is pending. The time
stipulated for grievance redressal is 30 days as per Ext. P9.
6. Having considered the submissions, I am of the opinion
that necessary directions can be issued to the District Level Grievance
Redressal Committee constituted as per Ext.P9 to hear the grievance of
the petitioner and take appropriate decision within the time frame
mentioned therein.
7. The District Level Grievance Redressal Committee
represented by its Convenor, the District Collector, is suo motu impleaded
as the additional respondent. The learned Government Pleader takes
notice.
Resultantly, this petition is disposed of directing the District Level
Grievance Redressal Committee before whom the grievance raised by the
petitioner is pending to consider the grievance of the petitioner herein and
to take a decision within thirty days, the time frame mentioned in Ext.P9.
Sd/-
RAJA VIJAYARAGHAVAN V
JUDGE
sru
APPENDIX OF WP(C) 29689/2023
PETITIONER'S EXHIBITS
Exhibit P1 TRUE COPY OF THE HEALTH-CARD ISSUED TO THE
PETITIONER THROUGH THE MEDISEP PORTAL.
Exhibit P2 TRUE COPY OF THE SCREEN SHOT OF THE WELCOME
SCREEN OF THE 'MEDISEP' PORTAL.
Exhibit P3 TRUE COPY OF THE LETTER OF ESTIMATION OF
EXPENSES FOR UNDERTAKING DBS SURGERY ISSUED BY
ASTER MEDCITY DATED: 23.06.2023.
Exhibit P4 TRUE COPY OF THE E- MAIL DATED: 04.07.2023 SENT
BY THE PETITIONER TO THE PROJECT HEAD,
'MEDISEP', ORIENTAL INSURANCE COMPANY ASKING
THE PROCEDURE TO BE FOLLOWED FOR AVAILING THE
BENEFIT.
Exhibit P5 TRUE COPY OF THE REPLY ISSUED BY THE PROJECT
HEAD, 'MEDISEP' DATED: 25.07.2023.
Exhibit P6 TRUE COPY THE SCREENSHOT AVAILABLE IN RESPECT
OF THE COMPLAINT REGISTERED BY THE PETITIONER
BEFORE THE DISTRICT AUTHORITY USING THE TOKEN
NUMBER.
Exhibit P7 TRUE COPY OF THE SCREENSHOT FROM THE 'MEDISEP'
PORTAL SHOWING THE LIST OF HOSPITALS EMPANELLED
FOR NEUROSURGERY IN ERNAKULAM DISTRICT.
Exhibit P8 TRUE COPY OF THE LIST OF ALL THE EMPANELLED
HOSPITALS IN ERNAKULAM DISTRICT AS PER THE
'MEDISEP' PORTAL.
Exhibit P9 TRUE COPY OF THE G.O.(P)NO.70/2022 FIN DATED:
THIRUVANANTHAPURAM 23.06.2022.
Exhibit P10 TRUE COPY OF BILL NO. OPCA24/271609 DATED:
27.07.2023 FOR ₹5.870.00.
Exhibit10(a) TRUE COPY OF BILL NO. IPCA24/277343 DATED:
28.07.2023 FOR ₹40,193.00
ExhibitP10(b) TRUE COPY OF BILL NO. IPCA24/320729 DATED:
14.08.2023 FOR ₹10,00,000.00.
ExhibitP10(c) TRUE COPY OF BILL NO. OPCA24/320941 FOR
₹2,388.85 DATED: 14.08.2023.
