Madras High Court
P.Lakshmanan vs State Of Tamil Nadu on 6 January, 2022
W.P(MD)No.20360 of 2021
BEFORE THE MADURAI BENCH OF MADRAS HIGH COURT
Dated: 06.01.2022
CORAM:
THE HONOURABLE MR.JUSTICE B.PUGALENDHI
W.P(MD)No.20360 of 2021
and
W.M.P(MD)No.17008 of 2021
P.Lakshmanan ... Petitioner
Vs
1.State of Tamil Nadu,
Rep. by its Additional Chief Secretary to Government,
Department of Finance,
Fort St.George,
Chennai – 9.
2.The Commissioner of Treasuries and Accounts
/ Joint Director,
3rd Floor, Veterinary Hospital Campus,
No.571, Nandhanam, Anna Salai,
Chennai – 600 035.
3.The District Level Empowered Committee,
Rep. by the District Collector,
Pudukottai District.
4.The Senior Divisional Manager,
United India Insurance Company,
Divisional Office VI,
5th Floor, PLA Rathna Tower,
212, Anna Salai, Chennai – 6. ... Respondents
PRAYER: Writ Petition filed under Article 226 of the
Constitution of India for issuance of writ of
1/12
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W.P(MD)No.20360 of 2021
Certiorarified Mandamus, to call for the entire records
relating to the impugned proceedings in O.Mus.No.
20013/Pu.Ma.Ka.Thi-3/2021, dated 11.08.2021 on the file of
the second respondent and quash the same and further direct
the respondents to reimburse the medical expenses of
Rs.1,38,793/- payable to the petitioner with interest at
the rate of 12% per annum for the delayed payment in the
light of the judgment of the Hon'ble Supreme Court in Shiva
Kant Jha v. Union of India, reported in AIR 2018 SC 1975
and the judgment of the Hon'ble Madurai Bench of Madras
High Court in W.P.(MD)No.13429 of 2013, dated 28.05.2019,
within a stipulated time limit.
For Petitioner : Mr.T.Aswin Rajasimman
For Respondent : Mr.S.Saji Bino,
Nos.1 to 3 Special Government Pleader
For Respondent : Mr.A.Shajahan
No.4
ORDER
This writ petition has been filed seeking for
reimbursement of Rs.1,38,793/- spent towards Covid-19
treatment for the petitioner, who is working as Headmaster
in Government Higher Secondary Schol, Avoor, Pudukottai
District.
2.The grievance of the petitioner is that the
petitioner is a subscriber to the Government of Tamil Nadu
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W.P(MD)No.20360 of 2021
New Health Insurance Scheme. He has incurred a sum of
Rs.1,38,793/- towards his Covid-19 treatment expense in the
month of October 2020. The petitioner sent a representation
to the respondents seeking reimbursement of the said
amount. But the claim of the petitioner has been rejected
vide impugned order.
3.The learned Counsel for the petitioner submits that
the petitioner experienced symptoms of Covid-19 and got
admitted in Thilagavathy Hospital, Kamaraj Nagar, Airport,
Trichy, on 09.10.2020, which is closer to his residence. He
took treatment in the said Hospital till 16.10.2020.
Totally he has incurred a sum of Rs.1,38,793/-. The learned
Counsel for the petitioner has also relied on the medical
documents for having taken treatment for Covid-19 at
Thilagavathy Hospital, Kamaraj Nagar, Airport, Trichy.
4.Mr.A.Shajahan, learned Standing Counsel appearing for
the fourth respondent / Insurance Company submitted that
the petitioner has taken treatment in a non-network
hospital for a non-critical issue. He also placed his
reliance in Clause 4(iv)(vi) of G.O.Ms.No.280, Finance
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W.P(MD)No.20360 of 2021
[Salaries] Department, dated 24.06.2020, which reads as
follows:
“4.(iv)(vi) Government Employees / Pensioners,
who have already taken treatment for Non – critical
COVID care in empanelled Hospitals from 01.03.2020
to till date are directed to submit their claims
for reimbursements by appealing to the Commissioner
of Treasuries and Accounts shall recommend to the
United India Insurance Company Limited to reimburse
the payment from the Corpus fund provided by the
Government.”
5.The learned Counsel has also relied on the letter of
the Additional Chief Secretary, Finance (Salaries)
Department in letter No.36962/Finance(Salaries)/2020, dated
11.11.2020 and submits that non critical Covid-19 claims as
per G.O.Ms.No.280, Finance (Salaries) Department, dated
24.06.2020 can be made only in empaneled and Covid
authorised hospital and critical care, which is covered in
New Health Insurance Scheme, shall be covered as per
existing contract. Therefore, the petitioner is not
entitled for the claim.
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W.P(MD)No.20360 of 2021
6.Heard the learned Counsel appearing on either side
and perused the documents placed on record.
7.During the month of October 2020, since the
petitioner experienced the symptoms of Covid-19, he was
admitted in Thilagavathy Hospital, Trichy, wherein he was
diagnosed with Covid-19 and was provided treatment.
The petitioner based on the medical documents and receipts
issued by the hospital, made an application seeking
reimbursement. The application finally landed before the
second respondent, who rejected the claim of the petitioner
stating that the claim of the petitioner falls under the
category of Non-critical at Non-Empanelled hospital and his
claim is not covered under the National Health Insurance
Scheme.
8.The National Health Insurance Scheme for Employees
and Pensioners / Family Pensioners was introduced in the
year 2008 and subsequently it was extended from time to
time by respective Government Orders. This Health Insurance
Scheme is being implemented with an object of 'cashless
treatment' to the Government Employees, Pensioners and
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W.P(MD)No.20360 of 2021
Family Pensioners. The agreement was entered into between
the Government and the United India Insurance Company
Limited in the year 2016 for a period of four years, which
has been subsequently renewed in the year 2018 and of late,
renewed in the year 2021.
9.The Government has published a list of approved
treatments and surgeries and a list of empaneled network
hospitals. The employee, who takes treatment for a
particular illness in a particular hospital, mentioned in
the list is entitled for cashless treatment subject to the
ceiling limit and the Insurance Company shall directly make
payment to the hospital.
10.Covid-19 is not mentioned in the said list of
illness. The Government considering the same, vide
G.O.Ms.No.280, Finance [Salaries] Department, dated
24.06.2020, has included new packages for treatment of
critical and non-critical care for Covid-19 positive cases
under New Health Insurance Scheme for Employees and
Pensioners and also fixed the ceiling rate for payment to
the private hospitals. As per the said Government Order,
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W.P(MD)No.20360 of 2021
for critical care, the Insurance Company shall make
payments to the empaneled hospitals as per the recommended
rates in para(i) and for non critical care, the Government
has authorised the Insurance Company Limited to form two
separate corpus funds, viz., (i) Corpus Fund for Covid-19
treatment in empanelled hospitals under New Health
Insurance Scheme for Employees – Rs.5 Crore and (ii) Corpus
Fund for Covid-19 treatment in empanelled hospitals under
New Health Insurance Scheme for Pensioners/ Family
Pensioners – Rs.2.5 Crore. The Insurance company shall
make payments for Covid-19 treatment as per the rates
recommended in the Government Order and the Government
sanctioned a sum of Rs.5 Crore and Rs.2.5 Crore for New
Health Insurance Scheme towards contribution to the two
corpus funds. This Government Orders cover both critical
care and non critical care. The Government has also
sanctioned two corpus funds for making payment to the
hospitals by the Insurance Company.
11.The claim of the petitioner has been rejected on the
ground that non-critical and non-network hospital, i.e.,
the petitioner has taken treatment for
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W.P(MD)No.20360 of 2021
non-critical issue in a non-network hospital and therefore,
he is not entitled for reimbursement.
12.Covid-19, a new form of virus, which this century is
facing as pandemic for the past two years. There is no
prescribed medicine or treatment for curing covid-19.
The research as of now shows that the virus enters the
lungs of the body, multiples in number and thereby affects
the entire respiratory system at any point of time, leading
to asphyxia and several other disorders, which require
immediate attention and immediate health care. The entire
world has seen the huge number of persons contracted with
Covid-19 and even now the number is huge. Most of the
hospitals were flooded with covid-19 patients, requiring
immediate treatment. Even there were scenes, patients
waiting in front of the hospitals for want of beds for
being admitted. We have also come across the deaths due to
shortage of beds, shortage of oxygen and due to other
reasons being reported daily in medias.
13.The petitioner has enrolled in the New Health
Insurance Scheme for Employees and has been paying
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W.P(MD)No.20360 of 2021
subscription every months. The petitioner experienced the
covid-19 symptoms, immediately admitted in a nearby
Hospital, diagnosed with Covid-19 and was provided
treatment.
14.When such being the nature of the illness,
it is not acceptable to state that Covid-19 cannot be
termed as critical care. Therefore, rejecting the claim on
the ground of non-critical care cannot be sustained.
Further, a Covid-19 contracted person, who is battling for
life, shall not be in a position to search for a network
hospital / empaneled hospital leisurely for taking
treatment. Therefore, the reason of non-network hospital
cannot be accepted.
15.The Government vide G.O.Ms.No.280, Finance
[Salaries] Department, dated 24.06.2020, has included new
packages for treatment of critical and non-critical care
for Covid-19 positive cases under New Health Insurance
Scheme for Employees and Pensioners and also fixed the
ceiling rate for payment to the private hospitals by
sanctioning two carpus funds.
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W.P(MD)No.20360 of 2021
16.It is an admitted fact that the petitioner has
contracted covid-19 and taken treatment. The Insurance
Company has not disputed the same.
17.In the light of the above discussion, the impugned
rejection order is set aside and this writ petition is
disposed of, with a direction to the fourth respondent /
United India Insurance Company to consider the case of the
petitioner and make payment as directed in G.O.Ms.No.280,
Finance [Salaries] Department, dated 24.06.2020, within a
period of twelve weeks from the date of receipt of a copy
of this order. No costs. Consequently, connected
miscellaneous petition is closed.
06.01.2022
Index : Yes / No
Internet : Yes / No
gk
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.
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W.P(MD)No.20360 of 2021
To
1.The Additional Chief Secretary to Government,
State of Tamil Nadu,
Department of Finance,
Fort St.George,
Chennai – 9.
2.The Commissioner of Treasuries and Accounts
/ Joint Director,
3rd Floor, Veterinary Hospital Campus,
No.571, Nandhanam, Anna Salai,
Chennai – 600 035.
3.The District Collector,
District Level Empowered Committee,
Pudukottai District.
https://www.mhc.tn.gov.in/judis
W.P(MD)No.20360 of 2021
B.PUGALENDHI, J.
gk
W.P(MD)No.20360 of 2021
06.01.2022
https://www.mhc.tn.gov.in/judis
