Mrs.Lalitha Parameswaran vs The Principal Secretary / Director Of
2024 Latest Caselaw 5070 Mad

Citation : 2024 Latest Caselaw 5070 Mad
Judgement Date : 4 March, 2024

Madras High Court

Mrs.Lalitha Parameswaran vs The Principal Secretary / Director Of on 4 March, 2024

                                                                                W.P.No.8080 of 2020

                                  IN THE HIGH COURT OF JUDICATURE AT MADRAS

                                               DATED : 04.03.2024

                                                      CORAM

                                  THE HONOURABLE MS.JUSTICE R.N.MANJULA

                                               W.P.No.8080 of 2020

                     Mrs.Lalitha Parameswaran                                     ... Petitioner
                                                    Vs.

                     1.The Principal Secretary / Director of
                         Treasuries Accounts,
                       Directorate of Treasuries Accounts,
                       Amma Valagam, 3rd Floor,
                       Nandanam, Anna Salai,
                       Chennai 600 035.

                     2.The Director,
                       Director of Medical and Rural Health Services,
                       359, Anna Salai,
                       Chokkalingam Nagar,
                       Teynampet, Chennai 600 006.

                     3.The Divisional Manager,
                       United India Insurance Company Limited,
                       Divisional Office - VI,
                       PLA Rathna Tower, 5th Floor,
                       212, Anna Salai, Chennai 600 006.                      ... Respondents
                     Prayer: Writ Petition is filed under Article 226 of the Constitution of
                     India, to issue a Writ of Certiorarified Mandamus, to call for the records
                     relating to the communication passed by the first respondent in


                     Page No.1 of 10


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                                                                                          W.P.No.8080 of 2020

                     Mu.Mu.No.014620/O.Pu.Ma.Ka.Th/2019 dated 26.04.2019 and quash
                     the same and direct the respondents to disburse the medical claim.

                                         For Petitioner        : Mr.K.Rajasekaran
                                         For Respondents       : Mr.S.Arumugam, GA

                                                          ORDER

This Writ Petition has been filed for the issuance of a Writ of

Certiorarified Mandamus, to call for the records relating to the

communication passed by the first respondent in

Mu.Mu.No.014620/O.Pu.Ma.Ka.Th/2019 dated 26.04.2019 and quash

the same and direct the respondents to disburse the medical claim of the

petitioner.

2. Heard Mr.K.Rajasekaran, learned counsel for the petitioner and

Mr.S.Arumugam, learned Government Advocate for the respondents.

3. The petitioner is aggrieved due to the rejection of the claim for

medical reimbursement of the petitioner's late husband

H.S.Parameswaran who is a pensioner. The husband of the petitioner is a

Government Servant. According to the petitioner, the petitioner's husband

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is a subscriber of the health insurance scheme of the United India

Insurance Company. The petitioner's husband had undergone a procedure

in Orthopedic / Arthoplasty surgery in a network hospital. Subsequent to

Arthoplasty surgery, the petitioner's husband developed Cardio

Respiratory arrest and Cardiogenic shock and he died on 05.02.2017.

Despite repeated request made by the petitioner, the sanction of medical

reimbursement was not made.

4. However, the petitioner was informed that the District Level

Empowered Committee had recommended the petitioner's entitlement for

reimbursement to the State Level Empowered Committee. However, the

first respondent sent a communication stating that the matter would be

placed before the High Level Empowered Committee. The impugned

order has been passed without stating any reason as to why the

petitioner's claim was not accepted by the High Level Empowered

Committee. Hence the petitioner is before this Court.

5. The petitioner's husband is a pensioner and a senior citizen who

got retired a decade before and died on 05.02.2017. For atleast six years,

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the petitioner who is also a senior citizen was running from pillar to post

to get the medical reimbursement. In the communication dated

26.04.2019, it is stated that the High Level Empowered Committee will

decide about the entitlement of the petitioner. The District Level

Committee has rejected the claim of the petitioner by stating that the

treatment taken by the petitioner's husband is not a recognised treatment.

By communication dated 02.04.2018, the Director of Rural Health and

Medical Services has informed the petitioner that the treatment was taken

in network hospital but the hospital is having only cardio procedure. The

individual was treated for Bipolar Arthroplasty Right Hip. As this

procedure is not covered in this hospital, the Committee rejected the claim

of the petitioner.

6. The very claim of the petitioner is that the individual was treated

for Bipolar Arthroplasty and he developed cardiological complications

subsequent to the procedure. The reason for rejection of the petitioner's

claim is that the hospital is not recognised for particular treatment despite

it is found place in the list of network hospitals. Series of judgments have

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been rendered that rejection of medical reimbursement cannot be made on

the ground that the hospital is not a network hospital or not a listed

treatment. So far as the treatment taken by the deceased husband of the

petitioner is concerned it was provided in Hariharan hospital and it was

only a network hospital. Hence the respondents should not make the

senior citizen like the petitioner to run from pillar to post stating reasons

according to their whims.

7. In this regard, clear guidelines have already been given in the

judgment of this Court made in a batch of Writ Petitions in W.P.(MD)

Nos.13429 of 2013 etc.,dated 28.05.2019 (S.Marimuthu Vs. The

Government of Tamil Nadu and others), as under:

"80. In order to reconsider all these claim made by the respective writ petitioners for medical reimbursement, by remitting the matters back, the following directions are issued:

(i) All the impugned orders in the respective writ petitions in this batch of cases, are hereby quashed.

(ii) The writ petitions where impugned orders are

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quashed as well as the writ petitions where mandamus sought for, are hereby remanded with directions to the concerned District Level Empowered Committee, before whom, these matters shall be placed and the Committee shall reconsider every individual case.

(iii) While reconsidering, the Committee shall not reject any claim merely on the reason of non network hospital or non listed disease.

(iv) The Committee, wherever possible, shall give suitable direction to the Insurance Company to reimburse the claim made by the respective claimant / employee / pensioner.

(v) If the Committee finds some cases where the Insurance Company cannot be directed to reimburse, in those cases, suitable orders shall be passed directing / recommending the State authorities to reimburse the claim under Medical Attendance Rules.

(vi) Once such orders are passed, the Insurance Company shall immediately reimburse the medical claim with 6% interest from the date of due till date of payment, within a period of thirty days from the date of receipt of such order to be passed by the Empowered Committee of the District concerned.

(vii) On receipt of such orders / recommendation

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from the Empowered Committee, the Sanctioning authority / State authority / High Power Committee in the State Level shall pass necessary orders allowing the medical reimbursement claimed by the individual claimant / employee / pensioner under the Medical Attendance Rules.

(viii) While ordering medical reimbursement under Medical Attendance Rules, the rate approved, accepted or quoted by the Insurance Company under the Medical Insurance Scheme shall be taken as the rate and by calculating the reimbursement on the said rate, the reimbursement claim shall be immediately sanctioned and the amount shall be reimbursed to the claimant with 6% interest form the date of due till date of payment, within a period of thirty days from the receipt of the recommendation / order from the District Empowered Committee."

8. The respondents did not consider the Clauses (v) and (vii) of the

above judgment in order to enable the petitioner to get the medical

reimbursement. No where it is stated by the respondents that the

petitioner has made a claim for medical reimbursement on the basis of

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any false treatment. The treatment given to the petitioner’s husband is

genuine. Since the respondents does not claim that the hospital in which

the petitioner's husband was given treatment is a non-network hospital,

no much fuss can be made in respect of the disease for which the

petitioner’s husband had taken treatment. Hence the impugned order is

liable to be set aside.

9. In view of the above stated reasons, this Writ Petition is allowed