2006 Supreme(Mad) 1736
High Court of Judicature at Madras
THE HONOURABLE MR. JUSTICE N. PAUL VASANTHAKUMAR
G. Elavazhagan - Appellant
Versus
Commissioner of Treasuries and Accounts & Others - Respondents
W.P.No.21235 of 2006 & M.P. Nos.1 & 2 of 2006
Decided On : 11 July 2006
Madras Medical Mission Hospital is an approved hospital.
Headnote:Tamil Nadu Government Employees Health Fund Scheme, 1991 - G.O.Ms. No. 400, Finance Department, dated 29.8.2000 - Rejection of clai for medical reimbursement-Madras Medical Mission Hospital is an approved hospital - The list of diseases for which the reimbursement can be claimed also contains open heart surgery including valve replacement - Denial of reimbursement for the petitioner is illegal - Claim allowed.
(Petition filed under Article 226 of the constitution of India to issue a writ of Certiorarified Mandamus for the relief as stated therein.)
The prayer in the writ petition is to issue a writ of certiorarified mandamus calling for the records pertaining to the order passed by the first respondent in his proceedings CTA N.Dis.59122/H4/2005 dated 30.12.2005 and the consequential order passed by the 2nd respondent in hid proceedings Mu.Mu.No.5845/A1/2002 dated 04.5.2006 as communicated by the third respondent in his proceedings O.Mu.No.1029/02/A1 dated 17.5.2006 and quash the same and direct the respondents to receive application for claiming Medical Assistance from the petitioner under Tamil Nadu Government Employees Health Fund Scheme, 1991 for the surgery underwent by the petitioner's wife E.Jothi and consequently to pay the medical assistance of Rs.1 lakh to the petitioner.
2. The brief facts, necessary for the disposal of the writ petition are that the petitioner was appointed as Headmaster of Elementary School on 20.6.1966 and transferred to Panchayat Union Elementary School, Chennappanaickanoor, Uthangarai Union and the petitioner reached superannuation on 19.7.2002 and he was allowed to continue in service on re-employment basis till 31.5.2003. The petitioner while working in the said post, his wife E.Jothi underwent heart operation at Madras Medical Mission Hospital, Mogappair on 09.7.2002 and the hospital diagnosed that the petitioner's wife was suffering from 'severe calcific As Grade II AR Moderate PAH, Severe LV Dysfunction". After diagnosis, the hospital authorities came to a conclusion that valve replacement should be done and there is no alternate way of treatment. Accordingly, on 10.7.2002, Open Heart Surgery was done to the petitioner's wife in the said hospital for valve replacement. The petitioner's wife was discharged from the hospital on 19.7.2002 and for the said valve replacement, the petitioner spent a sum of Rs.1,95,140/- towards surgery including medical expenses.
3. The petitioner is a member of Tamil Nadu Government Employees Health Fund Scheme and as per the above scheme if any member of the family is affected, 75% of the expenses incurred Rs.1,00,000/- which ever is high can be reimbursed. The Government issued orders in G.O.Ms. No.400, Finance Department, dated 29.8.2000 in which they have listed approved hospitals and list of diseases/surgeries/treatment. The Government servants are entitled to claim reimbursement for the medical treatment under the above scheme. The petitioner based on the said Government Order claimed an amount of Rs.1,00,000/- on 16.8.2002 in the prescribed form for which there was no reply. Therefore, the petitioner sent a complaint to the Chief Minister's Special Cell on 11.3.20 04 and thereafter the second respondent sanctioned the medical assistance for Rs.1,00,000/- by order dated 13.7.2004. The second respondent as per the orders dated 13.7.2004, requested to issue demand draft payable on State Bank of India, Uthangarai to the petitioner. However, the first respondent by proceedings dated 19.8.2005, instead of sanctioning the amount, returned the papers rejecting the claim on the ground that name of surgery as per the Government Order may be noted in the sanction proceedings and the order of the second respondent may be cancelled. Subsequently, the second respondent by order dated 30.12.2005, rejected the claim on the ground that the disease/ surgery/treatment sanctioned in the proceedings is not included in G.O. Ms.No.400 Finance dated 29.8.2000 and the second respondent by order dated 04.5.2006, returned the proposal for medical assistance under the Health Fund Scheme. The said order cancelling the sanction order is challenged in this writ petition.
4. Heard the learned counsel for the petitioner as well as the learned Additional Government Pleader for respondents. I have considered the rival submissions.
5. The discharge summary issued by the hospital clearly st