Madras High Court
Appellant vs A.Kanagasabapathi on 13 February, 2025
Author: G.Jayachandran
Bench: G.Jayachandran
W.A.(MD)No.1156 of 2018
BEFORE THE MADURAI BENCH OF MADRAS HIGH COURT
DATED : 13.02.2025
CORAM:
THE HONOURABLE DR.JUSTICE G.JAYACHANDRAN
AND
THE HON'BLE MS.JUSTICE R.POORNIMA
W.A.(MD).No.1156 of 2018
and
C.M.P.(MD).No.8339 of 2018
The United India Insurance Co. Ltd.,
Division Office VI
5th Floor P.L.A Rathna Towers
No.212, Annasalai,
Chennai – 600 006.
: Appellant
Vs.
1.A.Kanagasabapathi
2.The Principal Secretary to Government (Expenditure),
Finance (Salaries) Department,
Secretariat,
Chennai – 600 009.
3.The Commissioner of Treasuries & Accounts,
2nd Floor, Panagal Building,
Jeenish Road,
Saidapet,
Chennai – 600 015.
4.The District Collector,
Virudhunagar District,
Virudhunagar.
1/7
https://www.mhc.tn.gov.in/judis
W.A.(MD)No.1156 of 2018
5.The District Treasury Officer,
District Treasury,
Virudhunagar.
: Respondents
PRAYER: Writ Appeal is filed under Clause 15 of Letters Patent to set aside the
order dated 27.03.2018 passed in W.P.(MD) No.22165 of 2016.
For Appellant : Mr.A.Shajahan
For Respondents : Mr.S.Balamurugan (for R1)
Mr.D.Gandhi Raj
Spl. Govt. Pleader (for R2 to R5)
***
JUDGMENT
(Judgment of the Court was delivered by DR.G.JAYACHANDRAN,J.)
The appellant, instead of complying with the direction of the learned
Single Judge, who was directed to consider the representation of the first
respondent/writ petitioner regarding reimbursement, de-hors of the fact that the
first respondent/writ petitioner has taken treatment in a non-network hospital
and the scheme is only to cover cashless treatment and not reimbursement of
the expenses already incurred, has filed the present writ appeal.
https://www.mhc.tn.gov.in/judis
2. The learned Single Judge has passed the above order directing the
appellant to consider afresh based on the order of the Division Bench of this
Court rendered in W.P.(MD).No.1408 of 2016 in the case of N.Raja vs. The
Government of Tamil Nadu, reported in 2016(3) CTC 394.
3. The contention of the appellant, who is the Nodal Officer of the
Insurance Company, is that the writ petitioner, who is a pensioner under the
Government of Tamil Nadu, has admitted his wife for treatment at Velammal
Medical College Hospital, Madurai on account of cardiac disease and on the
advice of the doctor, his wife underwent surgery and got discharged on
09.08.2017. He has allegedly spent Rs.1,79,144/- for her treatment. His
application seeking reimbursement under the Tamil Nadu New Health
Insurance Scheme, though recommended by the District Empowerment
Committee, the Insurance Company rejected the same on the ground that the
wife of the petitioner has taken the above said treatment in a non-network
hospital and therefore, the Insurance Company, who is the appellant herein, is
not authorised to reimburse the said claim.
https://www.mhc.tn.gov.in/judis
4.The issue that taking treatment in a non-network hospital will not
entail the claimant for reimbursement, has been considered earlier in a batch of
writ petitions by the Division Bench of this Court in Star Health and Allied
Insurance Co. Ltd. vs. A.Chokkar & another reported in 2010-2-L.W.90.
Again, the issue came up for consideration in N.Raja vs. The Government of
Tamil Nadu (supra), in which, the learned Single Judge has relied upon that the
writ petitioner is the pensioner and has been provided with health security
under the scheme, has to be provided with the benefit as per the procedure laid.
Even if the Tamil Nadu New Health Scheme 2014, introduced for cashless basis
treatment, it does not cover the instance, which is stated above. The writ
petitioner cannot be deprived of the benefit if there is other scheme which
covers the treatment. Mere taking treatment in a non-network hospital will not
deprive the claimant from seeking reimbursement. The learned Single Judge of
this Court in that case, after taking note of the fact that the writ petitioner's
reimbursement cannot be negatived by the Insurance Company only on the
ground that the treatment was taken in a non-network hospital, had directed the
appellant/respondent to quantify the amount to which, the petitioner is eligible
and sanction and reimburse the same within a period of six weeks from the date
of receipt of a copy of that order.
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5. It is to be noted that the responsibility to reimburse the medical
claim is primarily fixed on the Government, who is the former employer of the
claimant. The Insurance Company has come into picture to supersede the
liability on subscription to the Insurance Company. The appeal is preferred by
the Insurance Company and not by the State. This Court considering the said
fact earlier, had directed the parties to submit themselves for amicable
settlement through Lok Adalat. In fact, it is stated that the parties attended Lok
Adalat, but the proposal given by the State is not accepted by the writ
petitioner, who is first respondent in the appeal.
6. The learned counsel for the appellant emphasis that the terms of
the settlement proposal in the Lok Adalat to be implemented. This Court is
unable to endorse the said due. Any mode of dispute or settlement under
Section 89 of the Code of Civil Procedure, unless fortified and culminated in a
consensus, the proceedings cannot be taken into account by the Courts of
adjudication, the matter on merits. The writ appeal, therefore, disposed of
directing the appellant to consider the representation of the first respondent/writ
petitioner seeking reimbursement of the medical claim and pass appropriate
orders as per the law in force. Challenging the said direction in the writ appeal
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is un-merit without passing appropriate orders and therefore, the writ appeal
stands dismissed. No costs. Consequently, connected miscellaneous petition is
closed.
(G.J., J.) (R.P., J.)
skn 13.02.2025
NCC : Yes/No
Index : Yes / No
Internet : Yes
To
1.The Principal Secretary to Government (Expenditure),
Finance (Salaries) Department,
Secretariat,
Chennai – 600 009.
2.The Commissioner of Treasuries & Accounts,
2nd Floor, Panagal Building,
Jeenish Road,
Saidapet,
Chennai – 600 015.
3.The District Collector,
Virudhunagar District,
Virudhunagar.
4.The District Treasury Officer,
District Treasury,
Virudhunagar.
https://www.mhc.tn.gov.in/judis
DR.G.JAYACHANDRAN,J.
and
R.POORNIMA, J.
skn
and
13.02.2025
https://www.mhc.tn.gov.in/judis
