The court upheld the rights of the petitioner under the health insurance scheme and directed the hospital and the third respondent to fulfill their obligations.

1. The petitioner has got a son by name Naveen Kumar, who was born on 13.03.2012. On 03.08.2012, Naveen Kumar was suffering from high temperature, which resulted in FITS. In order to save the child, the petitioner immediately rushed him to a local private hospital known as “Kanna Hospital” at Dindigul. The doctors in the said hospital, then advised that the child should be shifted immediately to Apollo Hospital at Madurai (fourth respondent herein). Accordingly, the child was admitted in the fourth respondent hospital.

2. During the course of treatment, it was diagnosed that the child was suffering from Intususception, Respiratory Distress Syndrome, Seizure Disorder, Acute Renal Failure and SEPSIS. In view of the decreased respiratory effort with desaturation, the child was incubated on the date of admission and USG abdomen was done, which revealed features suggestive of intususception. By good efforts put in by the doctors, who attended on the child, the child improved gradually and thereafter, the child was shifted to the room. The child was thereafter discharged on 10.08.2012. For the treatment given in the fourth respondent hospital, Rs.1,05,795.46 was collected from the petitioner by the fourth respondent.

3. According to the petitioner, he and the other family members are enrolled members of the Chief Minister's Comprehensive Health Insurance Scheme, floated by the Government of Tamil Nadu by means of an agreement with M/s.United India Insurance Co.Ltd. As per the Memorandum of Understanding, for the treatment given to the child, whatever was the amount due on account of the treatment, should be claimed by the hospital from the third respondent / Insurance Company, under the Tamil Nadu Health Systems Project. But in this case, such course was not adopted by the fourth respondent, instead, the entire amount was collected from the petitioner. Therefore, the petitioner is before this Court with this writ petition, seeking a Writ of Mandamus to the respondents to refund the above said amount of Rs.1,05,795.46, to him.

4. I have heard the learned counsel for the petitioner, learned Government Advocate appearing for the first respondent, learned counsel appearing for the third respondent and the learned Senior Counsel appearing for the fourth respondent. I have also perused the records carefully.

5. In the counter filed by the third respondent / Project Manager, Tamil Nadu Health Systems Project, Chennai, it is stated in paragraphs-5 to 7 as follows:

“5. With reference to the allegations in para 8, I submit that it is true that intussusception is one of ailment, covered under the said scheme. The package rate for treating the said ailment under the said scheme is Rs.40,000/-. The said sum this Respondent would pay direct to the hospital and that the hospital is not expected to charge the patient any sum. We have come to know about the plight of the petitioner only on receiving the direction from 2nd Respondent dated 18.09.12. Immediately we initiated an enquiry into the issue and found that the hospital has failed in its duty in ensuring the treatment of the petitioner's child under the said scheme.

6. I submit that as already stated had the hospital treated the child under the said scheme, this Respondent is liable to pay a sum of Rs.40,000/-. Hence, this Respondent is ready and willing to deposit or pay the said sum of Rs.40,000/- to hospital. If this High Court finds that the petitioner is entitled to any sum more than Rs.40,000/-, the same is to be payable only by the 4th Respondent hospital.

7. I submit that under the scheme this Respondent pays the money directly to the hospital accordingly in this case this Respondent shall pay a sum of Rs.40,000/- to the hospital and that this High Court may direct the 4th Respondent hospital to return money received from the petitioner.”

6. Referring to the same, the learned counsel for the third respondent would submit that in the event the fourth respondent makes a claim,