Kerala High Court
Kanakalatha vs The Additional Chief Secretary ... on 20 February, 2024
1
WPC 6145/24
IN THE HIGH COURT OF KERALA AT ERNAKULAM
PRESENT
THE HONOURABLE MR.JUSTICE BASANT BALAJI
TUESDAY, THE 20TH DAY OF FEBRUARY 2024 / 1ST PHALGUNA, 1945
WP(C) NO. 6145 OF 2024
PETITIONER/S:
KANAKALATHA, AGED 79 YEARS W/O. PADMANABHAN,
KANAKASREE, ANAKUZHIKKARA, POOVATTUPARAMBA
PERUVAYAL, KOZHIKODE DT., PIN - 673008
BY ADV ANILKUMAR V. (VAZHARAMBIL)
RESPONDENT/S:
1 THE ADDITIONAL CHIEF SECRETARY (FINANCE- HEALTH
INSURANCE) SECRETARIAT, GOVERNMENT OF KERALA
THIRUVANANTHAPURAM, 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, ASTER MIMS HOSPITAL, MINI
BYEPASS ROAD, GOVINDAPURAM P.O., KOZHIKODE, PIN -
673016
4 THE MANAGER VIDAL HEALTH INSURANCE TPA LTD 3RD
PARTY ADMINISTRATOR DOOR NO 40/3232, 2ND FLOOR
PLAZA , PALARIVATTOM, COCHIN 25, PIN - 680025
5 THE CONVENER (DISTRICT COLLECTOR) DISTRICT LEVEL
GRIEVANCE REDRESSAL COMMITTEE COLLECTORATE
KOZHIKODE KOZHIKODE DISTRICT., PIN - 673001
OTHER PRESENT:
SR GP SMT MARY BEENA JOSEPH, SC SMT K.S SANTHI
THIS WRIT PETITION (CIVIL) HAVING COME UP FOR ADMISSION
ON 20.02.2024, THE COURT ON THE SAME DAY DELIVERED THE
FOLLOWING:
2
WPC 6145/24
JUDGMENT
(Dated this the 20th day of February 2024)
The petitioner challenges the rejection of the
MEDISEP reimbursement on the ground that pre-
authorisation was not obtained from the empanelled hospitals
before the knee replacement surgery. The petitioner joined the
MEDISEP scheme with I.D. No.1065160/Policy No.
441200/48/2023/337 (Pensioner ID 62231716) and was
regularly paying the monthly subscription without any default.
The petitioner was admitted in 3rd respondent hospital and
undergone a surgery for knee replacement. Though the
petitioner has informed the respondent hospital that she had
joined MEDISEP, the hospital did not get pre-authorisation
and later during discharge, she had to pay Rs.2,61,750/- as
hospital bill. The claim for reimbursement was rejected by the
Insurance company. Pointing out these facts, the petitioner
filed Ext.P8 representation on 12.2.2024 before the 5th
respondent and prayed for reimbursement of the medical
claim.
2. The counsel for the petitioner submits that a
direction may be issued to the 5th respondent to take up Ext.P8
and pass appropriate orders.
3. The Government Pleader as well as the standing
counsel for the Oriental Insurance company submit that
reimbursement is only possible in emergency cases. Since the
petitioner has already approached the Grievance Redressal
Committee with Ext.P8, there will be direction to the 5th
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) 6145/2024
PETITIONER EXHIBITS
Exhibit P1 TRUE COPY OF THE MEDISEP CARD OF THE PETITIONER
BEARING NO. 1065160 DATED NIL ISSUED BY THE SUB
TREASURY, KOZHIKODE
Exhibit P2 TRUE COPY OF THE EMPANELLED HOSPITALS, KOZHIKODE
DISTRICT WITH MEDISEP
Exhibit P3 TRUE COPY OF THE RELEVANT PAGE OF DISCHARGE
SUMMARY DATED 23.12.2023 ISSUED BY THE
4THRESPONDENT HOSPITAL
Exhibit P4 TRUE COPY OF THE MEDICAL BILL DATED 23.12.2023
ISSUED BY THE 4TH RESPONDENT HOSPITAL
Exhibit P5 TRUE COPY OF THE REJECTION EMAIL LETTER DATED NIL
ISSUED BY THE 2ND RESPONDENT
Exhibit P6 TRUE COPY OF THE RELEVANT PAGES OF NOTIFICATION
GO (P) NO. 70/2022/FIN DATED 23.06.2022 ISSUED
BY THE 1ST RESPONDENT
Exhibit P7 TRUE COPY OF THE RELEVANT PAGES OF NOTIFICATION
GO (P) NO. 63/2022/FIN DATED 31.03.2023 ISSUED
BY THE 1ST RESPONDENT
Exhibit P8 TRUE COPY OF THE REPRESENTATION DATED 07.02.2024
SUBMITTED BEFORE THE 5TH RESPONDENT COMMITTEE
