Madras High Court
P.Muthukrishnan vs The Director on 27 April, 2021
W.P(MD)No.7759 of 2021
BEFORE THE MADURAI BENCH OF MADRAS HIGH COURT
DATED: 27.04.2021
CORAM:
THE HONOURABLE MS.JUSTICE V.M.VELUMANI
W.P(MD)No.7759 of 2021
P.Muthukrishnan ... Petitioner
vs.
1.The Director,
Medical and Rural Health Services,
DMS Compound,
Teynampet,
Chennai – 600 006.
2.The District Collector,
Office of the Collectorate,
Tirunelveli District.
3.The Treasury Officer,
Office of the District Treasury,
Old Collectorate Complex,
Tirunelveli District.
4.The Manager,
United India Insurance Company Limited,
19, Nungampakkam High Road, IV Lane,
Chennai – 600 034. ... Respondents
PRAYER: Writ Petition filed under Article 226 of the Constitution of India
for issuance of a Writ of Mandamus, directing the respondents to
reimburse the medical expenses to a sum of Rs.60,867/- (Rupees Sixty
1/10
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W.P(MD)No.7759 of 2021
thousand and Eight Hundred and Sixty Seven only ) and Rs.1,04,653/-
(Rupees One lakh and Four thousand and six hundred and fifty three
only) in total Rs.1,65,520/- (Rupees one lakh and sixty five thousand
and five hundred and twenty only) to the petitioner by accepting his
applications, dated 08.01.2020 and 17.02.2020 within a time frame fixed
by this Court.
For Petitioner : Ms.P.Jessi Jeeva Priya
For RR 1 to 3 : Mr.M.Murugan
Government Advocate
For R – 4 : Mr.A.Shajahan
ORDER
This Writ Petition is filed seeking a Writ of Mandamus, directing the
respondents to reimburse the medical expenses to a sum of Rs.60,867/-
(Rupees Sixty thousand and Eight Hundred and Sixty Seven only ) and
Rs.1,04,653/- (Rupees One lakh and Four thousand and six hundred and
fifty three only) in total Rs.1,65,520/- (Rupees one lakh and sixty five
thousand and five hundred and twenty only) to the petitioner by
accepting his applications, dated 08.01.2020 and 17.02.2020 within a
time frame to be fixed by this Court.
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W.P(MD)No.7759 of 2021
2.Heard the learned counsel appearing for the petitioner,
Mr.M.Murugan, learned Government Advocate appearing for the
respondents 1 to 3 and Mr.A.Shajahan, learned counsel appearing for the
fourth respondent.
3.According to the petitioner, he was employed as Personal
Assistant to the Superintendent of Police, Tirunelveli in the Tamil Nadu
Police Department and retired from service on attaining the age of
superannuation on 30.11.2007. The petitioner's wife, namely,
M.Lakshmi, aged about 66 years, was diagnosed of WLE-Right Breast
Lump-Colloid Carcinoma Breast at Shri Uthradam Thirunal
Multi-speciality Hospital (SUT Hospital), Pattom Palace,
Thiruvananthapuram on 09.11.2019 and the pathology report was
received on 12.11.2019. Since the Doctor advised to remove the lump
immediately to avoid further spreading, the petitioner's wife was
admitted in the said SUT Hospital, Pattom on 22.11.2019 and underwent
excision right breast lump on 23.11.2019 and discharged on 24.11.2019.
The petitioner paid a sum of Rs.60,867/- towards the above medical
treatment and submitted an application before the third respondent on
08.01.2020, for reimbursement of the above medical expenses.
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W.P(MD)No.7759 of 2021
4.In the meantime, his wife had further complications and was
advised to remove the entire right side breast at the earliest and she was
admitted at KIMS, Trivandrum Hospital on 19.01.2020 and surgery was
done on 20.01.2020 and discharged on 21.01.2020. The petitioner paid
a sum of Rs.1,04,653/- towards the above medical treatment.
Thereafter, the petitioner submitted an application, dated 17.02.2020,
before the third respondent for reimbursement of the above medical
expenses. The third respondent forwarded the application, dated
08.01.2020 to the District Level Empowering Committee, headed by the
second respondent. After perusing the petitioner's claim, the Committee
accepted the same and forwarded to the fourth respondent. The third
respondent, by his proceedings in O.Mu.No.7334/2020/N1, dated nil
October, 2020 and further proceedings in Na.Ka.No.1416/2021/N1,
dated nil February 2021 has stated that the fourth respondent has
returned the petitioner's applications stating that the treatment taken in
a “Non-network Hospital”, need not be considered, as per
G.O.Ms.No.222, Finance (Pension) Department, Government of Tamil
Nadu, dated 30.06.2018. Seeking reimbursement of medical expenses,
the petitioner has come out with the present Writ Petition.
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W.P(MD)No.7759 of 2021
5.The learned counsel for the petitioner contended that as per
G.O.(Ms)No.391, Finance (Salaries) Department, dated 10.12.2018, the
petitioner is entitled for reimbursement of the amounts spent for the
treatment taken for her wife in a non-network hospital, as the
petitioner's wife had undergone surgery to remove the entire right side
breast on emergency basis. The learned counsel has also relied on the
order of this Court in N.Raja v. The Government of Tamil Nadu
reported in 2016(3) CTC 394, wherein this Court held that when an
employee underwent treatment in a non-network hospital in emergency,
the employee is entitled for reimbursement of medical expenses and
prayed for allowing the writ petition.
6.The learned Special Government Pleader appearing for the
respondents 1 to 3 and the learned counsel appearing for the second
respondent separately contended that the petitioner is residing at
Tirunelveli and knowing fully well that SUT Hospital, Pattaom and KIMS,
Trivandrum Hospital are Non-network Hospitals and took treatment for
his wife. Therefore, the petitioner is not entitled for reimbursement of
medical expenses from the respondents, as per the medical scheme. As
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W.P(MD)No.7759 of 2021
per the medical scheme, the respondents are liable to pay the medical
expenses, if only, the treatment taken in a network hospital approved by
the Secretary to Government, Finance (Salaries) Department, Chennai.
If treatment is taken in a Non-network Hospital, the respondents are not
liable to reimburse the medical expenses spent by the petitioner and
petitioner is not entitled to the relief sought for in the present writ
petition.
7.From the materials on record, it is seen that in an emergency,
the petitioner had underwent survey in removal of the entire right side
breast in SUT Hospital, Pattaom and KIMS, Trivandrum Hospital , which
are non-network hospitals. The Insurance Policy is in between the
Insurance Company, Government and its employer and the same is
contractual in nature. The Insurance Company will be liable to meet the
medical expenses only as per the terms of the insurance policy. The
learned counsel for the petitioner and the learned Special Government
Pleader contended that in the policy, it has been held that the
respondents are liable to pay the medical expenses, only if the treatment
is taken in a network hospital approved by them. The petitioner had
taken a treatment in a non-network hospital and therefore, the
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W.P(MD)No.7759 of 2021
respondents are not liable to pay the medical expenses incurred by the
petitioner. In the order relied on by the learned counsel for the
petitioner in the case of N.Raja v. The Government of Tamil Nadu
reported in 2016(3) CTC 394, it has been held that when an employee
undergoes treatment in an emergency in a non-network hospital, the
employee is eligible for reimbursement from the Government. Further,
in Clause 5(4) of G.O.Ms.No.391, dated 10.12.2018, it is stated that an
employee/eligible family members undergoes emergency
treatments/surgeries, not covered under this Scheme either in a network
Hospital or a Non-network Hospital, no claim can be filed under the New
Health Insurance Scheme. However, they shall be eligible for claim to the
extent permissible under the Tamil Nadu Medical Attendance Rules and
G.O.Ms.No.1023, Health and Family Welfare Department, dated
17.06.1980. As per the said Rules, the petitioner is entitled upto
Rs.2,00,000/-. In view of the Judgment of the Division Bench relied on
by the learned Single Judge in the order in N.Raja v. The Government
of Tamil Nadu reported in 2016(3) CTC 394 and G.O.(Ms)No.391,
dated 10.12.2018, the petitioner is entitled to the benefit of medical
reimbursement as per the Tamil Nadu Medical Attendance Rules. In view
of the same, the respondents are directed to pay the eligible amount as
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W.P(MD)No.7759 of 2021
per the Tamil Nadu Medical Attendance Rules to the petitioner, within a
period of twelve weeks from the date of receipt of a copy of this order.
8.With the above observations and direction, the Writ Petition is
allowed. No costs.
27.04.2021
Index : Yes / No
Internet : Yes / No
ps
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.
https://www.mhc.tn.gov.in/judis/
W.P(MD)No.7759 of 2021
To
1.The Director,
Medical and Rural Health Services,
DMS Compound,
Teynampet,
Chennai – 600 006.
2.The District Collector,
Office of the Collectorate,
Tirunelveli District.
3.The Treasury Officer,
Office of the District Treasury,
Old Collectorate Complex,
Tirunelveli District.
4.The Manager,
United India Insurance Company Limited,
19, Nungampakkam High Road, IV Lane,
Chennai – 600 034.
https://www.mhc.tn.gov.in/judis/
W.P(MD)No.7759 of 2021
V.M.VELUMANI,J.
ps
W.P(MD)No.7759 of 2021
27.04.2021
https://www.mhc.tn.gov.in/judis/
