Madras High Court

Bright Gnana Singh vs The Principal Secretary/ on 31 January, 2022

                                                                                   W.P.No.31757 of 2018

                                  IN THE HIGH COURT OF JUDICATURE AT MADRAS
                                                DATED 31.01.2022
                                                    CORAM

                        THE HONOURABLE MR.JUSTICE KRISHNAN RAMASAMY

                                                   W.P.No.31757 of 2018


                     C.Chellappan (Deceased)
                     1. Bright Gnana Singh
                     2. Bright Robinson
                        (petitioners 1 and 2 are substituted in the place of the
                        deceased, vide order, dated 31.01.2022 in
                        W.M.P.No.7130 of 2020 in this W.P.).
                                                                                       ...Petitioners


                                                           ..Vs..
                     1. The Principal Secretary/
                        Commissioner of Treasuries and Accounts,
                         Panagal Building,
                         Saidapet, Chennai-15.

                     2. The Joint Director of Health Service,
                        Kancheepuram.

                     3. The Joint Director,
                        District Treasury,
                        Kancheepuram.

                     4. The Additional Treasury Officer,
                        District Treasury,
                        Kancheepuram.
                                                                                   ...Respondents
                     PRAYER:-
                                  Petition filed under Article 226 of the Constitution of India

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                                                                                      W.P.No.31757 of 2018

                     praying for the issuance of Writ of Certiorarified Mandamus, after
                     calling for the records pertaining to the order dated 01.09.2017 in Ldis
                     No.14152/2017/H1 passed by the 3rd/4th respondent rejecting the
                     petitioner claim for reimbursement of medical expenses and returning the
                     same on the ground that my treatment period is not covered by the
                     scheme, quash the same and consequently direct the respondents to pay
                     the petitioner forthwith a sum of Rs.39,160/-, towards medical expenses
                     which he has incurred for undergoing hernia operation, with interest and
                     within a specified time as may be fixed by this Court, Award costs.


                                        For Petitioner     : Ms.Nandhini
                                                             for Mr.R.Krishnaswamy

                                        For Respondents : Mr.M.S.Prem Kumar,
                                                          Government Advocate

                                                            ORDER

This Writ Petition has been filed, challenging the order passed by

the 3rd/4th respondent, dated 01.09.2017, and to quash the same and

consequently, to direct the respondents to pay a sum of Rs.39,160/-,

towards the medical expenses incurred by the petitioner.

2. The facts of the case in brief are as follows:-

i) The petitioner, C.Chellappan (since deceased) worked as an

Office Assistant, in District Labour Office, Kaniyakumari and retired

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W.P.No.31757 of 2018

from service on his attaining the age of superannuation on 30.06.1980.

The Government, vide G.O.Ms.No.171 of Finance (Pension) Department,

dated 26.06.2014, introduced and implemented a new Scheme, called

“New Health Insurance Scheme, 2014 for Pensioners'', for providing

health care assistance to the pensioners, their spouses and also to the

family pensioners, and replaced the earlier Scheme, called ''Health Fund

Scheme, 1995''.

ii) The petitioner (since deceased) underwent a inguinal

hernioplast surgery on 15.08.2016, and incurred medical expenses of

Rs.39,109/-. Since the petitioner (since deceased) is a member to the

aforesaid new Scheme and he was issued with an Identity Card and was

paying the monthly subscription regularly, he made an application, dated

29.08.2016, to the first respondent along with all supportive documents

and requested for reimbursement of the said sum. The respondents 3 and

4, vide impugned order, rejected the claim made by the petitioner. Hence,

this Writ Petition for the aforesaid relief.

iii) During the pendency of this Writ Petition, the petitioner,

Chellappan passed away, as he was a nonagenarian (99 years old), his https://www.mhc.tn.gov.in/judis

W.P.No.31757 of 2018

legal heirs, viz., his two sons have filed W.M.P.No.7130 of 2020,

seeking to substitute themselves in the place of their deceased father and

the said Petition is ordered by this Court today and the legal heirs were

substituted in the place of the deceased as petitioners 1 and 2.

3. Ms.Nandhini, the learned counsel appearing for the petitioners

submitted that, the petitioners' father, deceased Chellappan was a

member of "New Health Insurance Scheme, 2014 for pensioners", which

was notified for a period of four years from 01.07.2014 to 30.06.2018

and for the said period, i.e.from 01.07.2014 to 30.06.2018, the

respondents have deducted a sum of Rs.150/- per month as subscription

towards the said Scheme regularly and from 01.07.2018, the respondents

have been deducting a sum of Rs. 350/- per month towards subscription

for the said Scheme. The learned counsel further submitted that the

petitioners' father was suffering from severe abdominal pain from

14.08.2016, and after clinical exam and texts, the Doctors diagonized

that he was suffering from inguinal hernia and suggested him to undergo

surgery and hence, the petitioners' father took medical treatment from

14.08.2016 and 20.08.2016, and underwent right inguinal hernioplasty

surgery on 15.08.2016 and spent a sum of Rs.39,109/-. https://www.mhc.tn.gov.in/judis

W.P.No.31757 of 2018

3.1 The learned counsel for the petitioner mainly contended that,

at the time, when the petitioners' father underwent surgery, the New

Health Insurance Scheme is in force and the petitioners' father after

getting cured from the disease made a claim reimbursement of the

amount. In fact, the third respondent forwarded the said application to

the second respondent, requesting him to settle the claim made by the

deceased Chellappan after taking decision through the Empowered

Committee headed by the District Collector, Kancheepuram. However,

the third/fourth respondents rejected the same, on the ground that the

period during which, the petitioners' father underwent the medical

treatment was not covered under the aforementioned Scheme.

3.2 The learned counsel for the petitioner contended that, the

impugned order is nothing but an outcome of non application of mind,

since, the petitioners' father underwent the treatment when the Scheme

was in force. Therefore, the learned counsel prayed for setting aside the

impugned.

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W.P.No.31757 of 2018

4. Mr.M.S.Prem Kumar, the learned Government Advocate for the

respondents submitted that the rejection has been made inadvertently on

the ground that the treatment period is not covered, but, in factuality, the

claim was rejected owing to the fact that the Hospital, where, the

petitioners' father underwent treatment is a Non-network Hospital and

the same is not in terms of policy issued by the Insurance Company.

Therefore, the learned Government Advocate submitted that the

petitioners are not entitled to seek for medical reimbursement and he has

referred to the para remarks made by the third respondent in the counter

affidavit, and sought for dismissal of the Writ Petition.

5. In reply, the learned counsel for the petitioner submitted that, if

it is the case of the respondents that the reason for rejecting the claim of

the deceased is not on the ground that the treatment period is not covered

under the Scheme, but, due to the reason that the Hospital, where, the

petitioners' father underwent treatment is a Non network Hospital and is

not covered by the policy of the Health Insurance Scheme, and reason

assigned in the impugned order is only a typographical error, then, the

petitioners have a good case, as this Court in catena of Judgements held

that the claim made for medical reimbursement cannot be rejected merely https://www.mhc.tn.gov.in/judis

W.P.No.31757 of 2018

on the ground of Non-network Hospital. Therefore, the learned counsel

submitted that, in the present case, the claim made by the petitioners'

father is genuine and hence, sought for a direction from this Court to

direct the respondents to refer the claim before the District Level

Empowered Committee for consideration.

6. Heard the learned counsel appearing for the petitioner and the

learned Government Advocate for the respondents and perused the

materials available on record.

7. It is clear that the petitioners' father, namely, the deceased

C.Chellappan worked in a recommended Organization and was a member

of “New Health Insurance Scheme, 2014 and 2018 for Pensioners'' and

he had also paid the subscription towards the Scheme every month

without fail. As ill luck would have it, the petitioners' father had suffered

inguinal hernia and underwent hernioplasty/surgery on 15.08.2016 and

spent about Rs.39,160/-. Hence, the petitioners' father made a claim for

reimbursement, however, the claim was rejected on the ground that the

treatment was not taken in a Network hospital, covered under the

Scheme, though the reason assigned in the impugned order for rejecting https://www.mhc.tn.gov.in/judis

W.P.No.31757 of 2018

the claim is only a typographical error, viz., the treatment period is not

covered under the Scheme.

8. As rightly pointed out by the learned counsel for the petitioner,

this Court in catena of Judgments categorically held that the claim made

towards medical reimbursement by the employees/pensioners under the

New Health Insurance Scheme cannot be rejected on the ground that the

treatment was not taken in the Network Hospital or such other reason,

and in this connection, I am reminiscent of a judgment passed by me

before the Madurai Bench of Madras High Court, in a batch of Writ

Petitions, viz., W.P.(MD) No.18055, etc. (batch) of 2020, dated

16.12.2020, and the relevant paragraphs of the said judgement are

extracted hereinbelow:-

"28. Thus, I am of the opinion that the claim of the petitioners cannot be rejected by the DLEC/SLEC on the grounds that the treatment was taken in a non-

network hospital or the disease is not covered under the package, but they have to consider the fact that the nature of treatment taken, emergency of treatment at the relevant point of time, and the urgent requirement of medical professionals, to treat the patients. In the event,

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W.P.No.31757 of 2018

if the reimbursement of medical claim is not covered under the New Health Insurance Scheme, in such case, the DLEC/SLEC shall consider the entitlement of the claimant under Tamilnadu Medical Attendance Rules or otherwise by the State as it may deem fit.

29. In cases, where, the respondents are satisfied with regard to the treatment taken by the petitioners, they have no locus standi to reject the claim of the petitoners on the ground that the petitioners took treatment in a Non-network Hospital"

8.1 Thus, the issue involved in this Writ Petition is no longer res

integra, and the same is covered by a decision rendered by me, in the

case referred to supra. In the light of the ratio decidendi laid down

therein, the order impugned herein is unsustainable and liable to be set

aside.

9. Accordingly, the impugned order, dated 01.09.2017, is set

aside and this Court, prima facie, is of the view that the petitioner is

entitled to make claim for reimbursement of the medical expenses of

Rs.39,160/-. Therefore, this Court directs the respondents 2 to 4 to

consider the claim made by the deceased father of the petitioners by

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W.P.No.31757 of 2018