Madras High Court
M.Mallika vs The Additional Chief Secretary To ... on 8 February, 2021
W.P.No.12121 of 2020
IN THE HIGH COURT OF JUDICATURE AT MADRAS
DATED 08.02.2021
CORAM :
THE HONOURABLE MR. JUSTICE S.VAIDYANATHAN
W.P.No.12121 of 2020
M.Mallika ... Petitioner
Vs
1. The Additional Chief Secretary to Government,
Finance Department,
Fort St. George,
Chennai 600 009.
2. The Director of Pensions,
Integrated Complex for Finance Department,
Animal Husbandry Hospital Complex,
Nandanam, Chennai 600 035.
3. The District Collector of Tirunelveli District/
Chairman, District Level Empowered Committee,
Tirunelveli.
4. The District Collector,
Tenkasi District,
Tenkasi.
5. The Joint Director of Medical & Rural Health Services,
Tirunelveli 627 009.
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W.P.No.12121 of 2020
6. The Treasury Officer,
District Treasury,
Tirunelveli.
7. The Assistant Treasury Officer,
Sub Treasury,
Tenkasi.
8. The Senior Manager,
United India Insurance Company Limited,
Divisional Office VI,
PLA Rathna Towers,
5th Floor, No.212, Anna Salai,
Chennai 600 006. ... Respondents
Writ petition filed under Article 226 of the Constitution of India,
praying to issue a writ of Certiorarified Mandamus, to call for the records
pursuant to the impugned order of rejection issued by the 8 th Respondent in
proceedings No.'Nil' dated 12.11.2019 and the consequential impugned order
issued by the 6th Respondent in Proceedings vide Na.Ka.No.9127/N.1/2019,
dated 12.12.2019 and quash these orders and consequently direct the
Respondents to pay a sum of Rs.5,25,980/- towards medical reimbursement
with interest at the rate of 12% per annum.
For Petitioner : Ms.Swadhi Subramaniam
For Respondents 1 to 7 : Mr.A.Arul Doss,
Additional Government Pleader
For 8th Respondent : Mr.P.Sankaranarayanan
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W.P.No.12121 of 2020
ORDER
Petitioner has come up with this Writ Petition seeking to quash the
impugned order of rejection issued by the 8th Respondent vide proceedings
No.'Nil' dated 12.11.2019 and the consequential impugned order issued by
the 6th Respondent in Proceedings vide Na.Ka.No.9127/N.1/2019, dated
12.12.2019 and for a consequential direction to the Respondents to pay a sum
of Rs.5,25,980/- towards medical reimbursement with interest at the rate of
12% per annum.
2. The Petitioner/pensioner has approached this Court against the
rejection order in respect of her medical claim for treatment. The request of
the petitioner for reimbursement of the medical expenses incurred by her, has
been rejected by the 8th and 6th Respondents, respectively. Having no other
alternative, she has approached this Court.
3. Heard the learned counsel on either side and perused the
material documents available on record.
4. While dealing with the similar issue of medical reimbursement,
this Court has considered all the aspects, referred to various judgments of this
Court and passed an elaborate order in W.P.No.2059 of 2017 [T.Balamani
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W.P.No.12121 of 2020
vs The Principal Secretary to Government, Finance (Salaries)
Department, Secretariat, Chennai-9 and others] decided on 27.02.2017
and directed the Government to sanction the amount to the Petitioner therein.
Relevant portion of the said order is extracted hereunder:
"The petitioner seeks to quash the impugned order
dated 04.10.2016, by which her request for medical
reimbursement was rejected on the ground that the
hospital, in which she underwent treatment is not an
approved hospital. The petitioner also sought a direction
to the 1st respondent to reimburse the medical expenses of
Rs.4,44,965/- to the petitioner with adequate interest
2. The petitioner, who was an employee during the
period of treatment and now attained superannuation, has
approached this Court against the rejection order in
respect of her medical claim for the treatment. The request
of the petitioner has been rejected by the Government
followed by the rejection of the High Level Committee.
3. Learned Government Advocate would submit
that the Government, having entered into a contract with
the Insurance Company and having paid huge amount to
them, cannot be compelled to reimburse the amount for
the second time. He would further submit that there are
number of net work hospitals in the State and it is
impermissible for the Government employees to choose
their own hospitals for treatment and thereafter claiming
reimbursement. If this practice is allowed, then the very
purpose of entering into the the contract with the
Insurance Company will be defeated.
4. Learned counsel for the petitioner would contend
that the Government issued an order in G.O.Ms.241
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W.P.No.12121 of 2020
Finance (Salaries) Department dated 24.08.2016, which
states that in order to redress the grievances of the
Government employees/pensioners under New Health
Insurance Scheme, District Level Empowered Committee
/ State Level Empowered Committee / High Level
Committee have been constituted, which will go through
the records and thereafter decide with regard to
reimbursement of the amount and prior to that, the
Government only extended the monetary benefits for the
treatment.
5. Heard the learned counsel on either side.
6. It is seen that the Government has entered into a
contract with the Insurance Company between the years
2014 and 2018 and as per the contract, the Insurance
Company is liable to pay the entire amount directly to the
network hospital and it cannot reimburse the amount in
terms of money, as the facility extended itself is the
cashless facility. But, at the same time, the State cannot
take a stand that there is no provision to reimburse the
amount to its employees in terms of money at all.
7. Admittedly, the petitioner has taken treatment in
a non-network hospital on account of emergent situation,
which ultimately resulted in rejection of her claim.
Subsequently, the High Level Committee has also rejected
the claim of the petitioner. It is not in dispute that if the
claim is approved, the petitioner would be paid the
medical benefits based on Tamil Nadu Medical
Attendance Rules (in short “the Rules”). The benefit of
scheme, namely, the contract cannot be rewritten and it is
only the Government to pay the amount incurred by the
petitioner/employee/ patient/pensioner irrespective of
constitution of the Committee. It is pertinent to mention
here that the patient cannot search for network hospital for
getting admitted or for taking treatment during emergency.
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W.P.No.12121 of 2020
8. This Court in the case of N.Raja vs. The
Government of Tamil Nadu, rep. by its Secretary,
Chennai and others, reported in 2016 (3) CTC 394, has
clearly held that when the Insurance Company is not liable
on account of the violation of the terms and conditions of
the contract, it is the duty of the Government to reimburse
the medical expenses incurred. The Hon'ble Division
Bench of this Court also, by order dated 16.12.2016 in
W.A.(MD) No.1579 of 2016 [MD India Healthcare
Services (TPA) Ltd., rep. by the Branch Manager,
Chennai, Chennai vs. K.Parameshwari and others],
directed the Government to reimburse the medical
expenditure. In view of the above, this Court is of the
view that pursuant to the existence of the contract, the
Insurance Company cannot be directed to pay the amount
and therefore, it is the Government, which is liable to
reimburse the amount.
9. Accordingly, this writ petition is allowed and the
impugned order dated 04.10.2016 is hereby set aside. The
concerned respondent, namely, the 1st respondent is
directed to sanction the medical expenses incurred by the
petitioner/employee/pensioner, as per the eligibility
criteria in terms of amount under the Scheme along with
interest @ 9% p.a. without standing on technicalities and
release the eligible amount within a period of two months
from the date of receipt of a copy of this order.
10. Before parting with the matter, it is suggested
that the Government shall ensure devising a proper
scheme so that the employees / pensioners, who are the
backbones for smooth running of Government
machineries are not made to run from pillar to post for
their claims, on the ground of technicalities being raised
by the Insurance Company."
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W.P.No.12121 of 2020
5. Finding that, the present issue on hand is squarely covered by
the judgment of this Court rendered in W.P.No.2059 of 2017 [T.Balamani
vs The Principal Secretary to Government, Finance (Salaries)
Department, Secretariat, Chennai-9 and others] decided on 27.02.2017,
the impugned orders dated 12.11.2019 and 12.12.2019 passed by the 8th and
6th Respondents respectively, are hereby set aside. The concerned
Respondents are directed to sanction the medical expenses incurred by the
Petitioner/pensioner as per the eligibility criteria in terms of amount under
the Scheme along with interest at 9% per annum without standing on
technicalities and release the eligible amount to the Petitioner within a period
of two months from the date of receipt of a copy of this order.
The Writ Petition is allowed with the above direction. No costs.
Consequently, connected W.M.P.No.14864 of 2020 is closed.
08.02.2021
Index : Yes/No
Speaking Order : Yes/No
(aeb)
To:
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W.P.No.12121 of 2020
1. The Additional Chief Secretary to Government,
Finance Department,
Fort St. George, Chennai 600 009.
2. The Director of Pensions,
Integrated Complex for Finance Department,
Animal Husbandry Hospital Complex,
Nandanam, Chennai 600 035.
3. The District Collector of Tirunelveli District/
Chairman, District Level Empowered Committee,
Tirunelveli.
4. The District Collector,
Tenkasi District, Tenkasi.
5. The Joint Director of Medical & Rural Health Services,
Tirunelveli 627 009.
6. The Treasury Officer,
District Treasury,
Tirunelveli.
7. The Assistant Treasury Officer,
Sub Treasury, Tenkasi.
8. The Senior Manager,
United India Insurance Company Limited,
Divisional Office VI,
PLA Rathna Towers,
5th Floor, No.212, Anna Salai,
Chennai 600 006.
https://www.mhc.tn.gov.in/judis/
W.P.No.12121 of 2020
S.VAIDYANATHAN,J.
(aeb)
W.P.No.12121 of 2020
08.02.2021
https://www.mhc.tn.gov.in/judis/
