Kerala High Court
Rosy M.J vs The Additional Chief Secretary ... on 5 April, 2024
WPC 13535/24 1
IN THE HIGH COURT OF KERALA AT ERNAKULAM
PRESENT
THE HONOURABLE MR.JUSTICE BASANT BALAJI
FRIDAY, THE 5TH DAY OF APRIL 2024 / 16TH CHAITHRA, 1946
WP(C) NO. 13535 OF 2024
PETITIONER/S:
ROSY M.J AGED 68 YEARS W/O. P.J. THOMAS, PUTHIYA
VEETTIL, PERUMPADANNA NORTH PARAVOOR P.O, ERNAKULAM
DIST., PIN - 683513
BY ADV ANILKUMAR V. (VAZHARAMBIL)
RESPONDENT/S:
1 THE ADDITIONAL CHIEF SECRETARY (FINANCE- HEALTH INSUR-
ANCE) SECRETARIAT GOVERNMENT OF KERALA THIRUVANANTHAPU-
RAM, KERALA., PIN - 695001
2 THE REGIONAL MANAGER THE ORIENTAL INSURANCE COMPANY LTD
METRO PALACE, NORTH RAILWAY STATION ROAD, ERNAKULAM
NORTH, ERNAKULAM., PIN - 682018
3 THE GENERAL MANAGER DIVINE HOSPITAL (MAX CARE HOSPITAL)
VADAKKANCHERY P.O. THRISSUR, PIN - 680582
4 THE CONVENER (DISTRICT COLLECTOR) THE DISTRICT LEVEL
GRIEVANCE REDRESSAL COMMITTEE COLLECTORATE, THRISSUR
THRISSUR DISTRICT., PIN - 680003
OTHER PRESENT:
SC SRI. K.S SANTHI, SR GP SMT MARY BEENA JOSEPH
THIS WRIT PETITION (CIVIL) HAVING COME UP FOR ADMISSION
ON 05.04.2024, THE COURT ON THE SAME DAY DELIVERED THE FOL-
LOWING:
WPC 13535/24 2
JUDGMENT
(Dated this the 5th day of April, 2024)
The petitioner challenges rejection of the MEDISEP
reimbursement on the ground that the benefit of MEDISEP
for knee replacement surgery is only to Government
hospitals. The petitioner joined the MEDISEP scheme with
I.D. No.1426040/Policy No. 441200/48/2023/336
(Pensioner ID 111070043) and was regularly paying the
monthly subscription without any default. The petitioner
was admitted in the 3rd respondent hospital and undergone
a surgery for knee replacement. The petitioner has
informed the respondent hospital that she had joined
MEDISEP, and it is understood that the hospital got pre-
authorisation. But, later during discharge, she had to pay
Rs.4,30,000/- as hospital bill. The hospital authorities
informed the petitioner that as per Ext.P4 Order, knee
replacement surgery is available only in
Government hospitals. Pointing out these facts, the
petitioner filed Ext.P5 representation on 24.5.2023 before
the 4th respondent and prayed for reimbursement of the
medical claim.
2. The counsel for the petitioner submits that a
direction may be issued to the 4th respondent to take up
Ext.P5 and pass appropriate orders.
3. In the facts and circumstances of the case and
since the petitioner has already approached the Grievance
Redressal Committee, 4th respondent with Ext.P5
representation, there will be direction to the 4th respondent
to consider the same, within a period of 2 months from the
date of receipt of a copy of this judgment.
With the above direction, the Writ Petition is
disposed of.
Sd/-BASANT BALAJI, JUDGE
dl/
APPENDIX OF WP(C) 13535/2024
PETITIONER EXHIBITS
Exhibit P1 TRUE COPY OF THE MEDISEP CARD ID NO.1426040 ISSUED BY
THE SUB TREASURY OFFICER PARAVOOR DATED NIL
Exhibit P2 TRUE COPY THE EMPANELLED HOSPITALS IN THRISSUR DIS-
TRICT DATED NIL
Exhibit P3 TRUE COPY OF THE DISCHARGE SUMMARY DATED 13.03.2023
ISSUED BY THE 3RD RESPONDENT HOSPITAL
Exhibit P4 TRUE COPY OF THE G.O (MS)NO. 63/2023 FIN IS PUBLISHED
ON 31.03.2023 BY THE 1ST RESPONDENT
Exhibit P5 TRUE COPY OF THE COMPLAINT FILED BY THE PETITIONER
BEFORE THE 4TH RESPONDENT COMMITTEE DATED 24.05.2023
BY THE 1ST RESPONDENT
