Annie Varkey vs State Of Kerala
2023 Latest Caselaw 11865 Ker

               IN THE HIGH COURT OF KERALA AT ERNAKULAM
                               PRESENT
         THE HONOURABLE MR. JUSTICE DEVAN RAMACHANDRAN
   FRIDAY, THE 17TH DAY OF NOVEMBER 2023 / 26TH KARTHIKA, 1945
                       WP(C) NO. 37967 OF 2023
PETITIONER:

          ANNIE VARKEY, AGED 67 YEARS
          PUKKUNNEL HOUSE, OPPOSITE LPG GODOWN, KOLENCHERRY,
          ERNAKULAM DISTRICT, KOCHI - 682311

          PAUL JACOB (P)
          SHERU JOSEPH
          MATHEW THOMAS
          NIKITTA TRESSY GEORGE



RESPONDENTS:

    1     STATE OF KERALA, REPRESENTED BY GOVERNMENT PLEADER,
          HIGH COURT OF KERALA, PIN - 682031

    2     VIDAL HEALTH INSURANCE TPA PVT. LTD.
          DOOR NO. 40/3232, 2ND FLOOR, S.L.PLAZA, PALARIVATTOM,
          KOCHI, PIN - 682020

    3     THE ORIENTAL INSURANCE COMPANY LIMITED
          GROUND FLOOR, METRO PALACE, OPPOSITE ERNAKULAM NORTH
          RAILWAY STATION, KOCHI, PIN - 682018

          SMT. VIDYA KURIAKOSE, GP,
          SMT. LATHA SUSAN


     THIS WRIT PETITION (CIVIL) HAVING COME UP FOR ADMISSION ON
17.11.2023, THE COURT ON THE SAME DAY DELIVERED THE FOLLOWING:
 WP(C) NO. 37967 OF 2023
                                  2


                              JUDGMENT

Even though the petitioner impugns Ext.P11 issued by the

third respondent, repudiating her claim preferred by her under

the Medical Insurance Scheme for State Employees and

Pensioners ('MEDISEP' for short), learned standing counsel for

the said respondent argued that this writ petition is not

maintainable because the 'MEDISEP' Scheme - a copy of which

has been produced and marked as Ext.P12 by the petitioner -

contains provisions for Dispute Resolution and Grievance

Redressal. She submitted that, therefore, the petitioner must

approach the appropriate Grievance Redressal Committee, and

thereafter the Appellate Authority, before she can seek any

further remedy before this Court.

2. I must say that there is some force in the afore

submissions of the learned counsel for the third respondent

because, when the petitioner seeks the benefit of Ext.P12 -

'MEDISEP' Scheme, obviously, she will have to act within the

parameters of its sanctions also. When the 'MEDISEP' Scheme

provides for Dispute Resolution and Grievance Redressal in a

particular manner, the jurisdiction of this Court cannot be

invoked, particularly under Article 226 of the Constitution of WP(C) NO. 37967 OF 2023

India, at the first instance. This is because, any resolution in this

regard can be done only after evaluation of germane facts and

documents, which this Court cannot do at this stage.

3. In the afore circumstances, I am certain that the

petitioner must invoke the provision under "Dispute Resolution

and Grievance Redressal" of Ext.P12 itself, rather than

impugning Ext.P11 directly before this Court.

4. However, taking note of the emergency projected by the

petitioner, I am certain that strict time frames will have to be

fixed and that this Court will be justified in doing so.

Resultantly, I allow this writ petition in the following

manner :-

(a) I grant liberty to the petitioner to move the appropriate

Grievance Redressal Committee; and if this is done under the

'MEDISEP' Scheme within a period of two weeks from the date

of receipt of a copy of this judgment, the same shall be decided,

after hearing her, as early as possible but not later than one

month thereafter.

(b) Should, for any reason, the afore exercise end against

the petitioner, then she will be at liberty to invoke the Appellate WP(C) NO. 37967 OF 2023

Authority against the order of the Grievance "Redressal

Committee"; and if that is done within a period of two weeks

after she receives the order, then it will also be decided by the

said Appellate Authority, after affording her an opportunity of

being heard, within a period of one month thereafter.

(c) Needless to say, the liberty of the petitioner to

approach this Court after the afore exercises are completed, is

always left open; for which purpose, all contentions are left

unanswered.

Sd/- DEVAN RAMACHANDRAN JUDGE stu WP(C) NO. 37967 OF 2023

APPENDIX OF WP(C) 37967/2023

PETITIONER EXHIBITS

Exhibit P1 TRUE COPY OF THE MEDISEP IDENTIFICATION CARD NUMBERED 1426700-1.

Exhibit P2 TRUE COPY OF THE STATUS REPORT SHOWING THE PETITIONER'S PAYMENT HISTORY TOWARDS THE SCHEME AND OTHER RELEVANT INFORMATION.

Exhibit P3 TRUE COPY OF THE LAB REPORT ADMINISTERED BY THE ASTER MEDCITY.

Exhibit P3(a) TRUE COPY OF THE DISCHARGE SUMMARY PREPARED BY ASTER MEDCITY DATED 10.12.2022 DETAILING THE PATIENT'S MEDICAL HISTORY, PROCEDURE DONE, AND A COMPREHENSIVE MEDICAL REVIEW.

Exhibit P4 TRUE COPY OF THE INPATIENT BILL NO.

IPCA23/533088 DATED 10.12.2022 WHICH AMOUNTS TO A TOTAL OF RS. 24,34,507/- AND CORRESPONDING TO THE HOSPITAL PACKAGE AND MEDICINES FOR THE TRANSPLANTATION PROCEDURE.

Exhibit P4(a) TRUE COPY OF THE OUTPATIENT BILL NO.

OPCA23/537960 AMOUNTING TO RS. 1,945.64/- AND CA23/1387/55398 AMOUNTING TO RS. 5425.28/- BOTH DATED 13.12.2022.

Exhibit P4(b) TRUE COPY OF BILL NO. OPCA23/536166 DATED 13.12.2022 AMOUNTING TO RS. 5,700/-

Exhibit P4(c) TRUE COPY OF BILL NO. OPCA23/536191 DATED 13.12.2022 AND AMOUNTING TO RS. 200/-.

Exhibit P4(d) TRUE COPY OF BILL NO. OPCA23/537800 DATED 13.12.2022 AND AMOUNTING TO RS. 950/-.

Exhibit P4(e) TRUE COPY OF BILL NO. CA23/1387/56852 AMOUNTING TO RS. 4385.25/- AND BILL NO. CA23/1387/56870 AMOUNTING TO RS. 957.50/- BOTH DATED 20.12.2022.

WP(C) NO. 37967 OF 2023

Exhibit P4(f) TRUE COPY OF BILL NO. 6616 DATED 20.12.2022 AMOUNTING TO RS. 2,020/-.

Exhibit P4(g) TRUE COPY OF BILL NO. OPCA23/5539334 DATED 20.12.2022 AMOUNTING TO RS. 500/-.

Exhibit P5 TRUE COPY OF THE LETTER ISSUED BY DR.

MATHEW JACOB AND NUMBERED AM/ILC/22/2830 DATED 26.12.2022.

Exhibit P6 TRUE COPY OF PART-A OF THE HEALTH INSURANCE CLAIM FORM DATED 28.12.2022 THAT WAS FILED BY THE PETITIONER AND SUBMITTED TO THE HOSPITAL.

Exhibit P7 TRUE COPY OF PART-B OF THE HEALTH INSURANCE CLAIM FORM DATED 28.12.2022 THAT WAS FILED BY THE HOSPITAL.

Exhibit P8 TRUE COPY OF THE PETITIONER'S APPLICATION LETTER DATED 28.12.2022 SEEKING REIMBURSEMENT ALONG WITH ANNEXURES.

Exhibit P9 TRUE COPY OF THE ACKNOWLEDGEMENT RECEIPT ISSUED BY THE 2ND RESPONDENT DATED 28.12.2022.

Exhibit P10 TRUE COPY OF THE JUDGMENT ISSUED BY THIS HON'BLE COURT IN WP(C) 31109 OF 2023 DATED 25.09.2023.

Exhibit P11 TRUE COPY OF THE REJECTION LETTER ISSUED BY THE 3RD RESPONDENT DATED 25.07.2023.

Exhibit P12 TRUE COPY OF THE MEDICAL INSURANCE SCHEME FOR STATE EMPLOYEES AND PENSIONERS.