The central legal point established in the judgment is the entitlement of petitioners to medical reimbursement under the New Health Insurance Scheme, 2012, and the government's obligation to reimburse the claimed medical expenses.

1. W.P.No. 13594 of 2013 is filed praying to quash the order dated 08/01/2013 issued by the United India Insurance Company Limited and direct the second respondent to consider the application made by the petitioner seeking medical reimbursement to the tune of Rs.2,91,887/-with interest at 12% per annum.

2. W.P.No. 29192 of 2013 is filed to quash the proceedings of the second respondent therein, viz., the District Collector, Nagapattinam District, and for a direction to reimburse the amount of Rs.2,50,000/- spent by the petitioner towards surgery of her husband with interest at 12% per annum.

3. The case of the petitioner in W.P.No. 13594 of 2013 are as follows:

(a) Petitioner entered into the service of this High Court on 05/03/2008 at Typist and was promoted as Assistant with effect from 24/08/2011 and he is now working as Assistant in the Establishment Section of High Court, Madras. He has enrolled himself under the New Health Insurance Scheme, 2012 introduced vide G.O.Ms.No.243 Finance Department, dated 29/06/2012. The Registrar General of this Court has issued a certificate, by which the petitioner is eligible to get medical reimbursement for himself and for his family members.

(b) Under the Scheme, health care assistance is provided to the employees of Government Departments. Public Sector Undertakings, Statutory Boards, Local Bodies, Universities and other State Government Organisations and Institutions to give medical assistance upto Rs.4 lakhs in a block period of four years commencing from 01/07/2012 to 30/06/2016 from the approved hospitals for listed treatments and surgeries.

(c) Petitioner’s elder son S. Aravind, aged about six years was diagnosed for cancer and initially he was admitted in M/s.Metha Hospital, Chetpet, Chennai. He was further treated at Kanchi Kamakodi Child Trust Hospital, and then at M/s.Adyar Cancer Institute. In spite of giving treatments in the above said hospitals, petitioner’s son S.Aravind died due to cancer on 22/11/2012.

(d) Petitioner, being a subscriber and eligible member under the New Health Insurance Scheme, 2012, to get cashless treatment for his son, produced necessary documents before the Hospital. However, the Hospital authorities pressurised the petitioner for payment in advance totalling a sum of Rs.2,91,887/- towards medical expenses. According to the petitioner, totally he incurred more than Rs.3,50,000/-, however, he is having receipt only for Rs.2,91,887/-.

(e) After demise of his son, petitioner submitted an application to the second respondent on 07/01/2013 for reimbursement of Rs.2,91,887/- enclosing payment receipts. The second respondent by its proceedings dated 08/01/2013 returned the application by stating that as per G.O.Ms.No.243 Finance Department Dated 29/06/2012, no payment is to be made by the employer to the approved hospital (network hospital) and payment will be made only after preauthorisation approval obtained from the Network Hospitals and any claim in deviation of the above procedure for reimbursement is liable to be rejected. As per the said Government order if there is any grievance in respect of claim, the shall be referred to the District Level Empowered Committee for redressal, and therefore the request of the petitioner was returned.

(f) The said order, returning the claim of the petitioner by the second respondent, is challenged in this writ petition contending that the petitioner being a Government Servant, even prior to the introduction of the New Health Insurance Scheme, he has opted for the Tamil Nadu Government Servants Health Fund Scheme and under the said Scheme, which was in vogue prior to the introduction of the New Health Insurance Scheme, 2012, reimbursement was permissible for the actual expenses made by the Claimants/dependants of the Claimants. Petitioner’s son having suffered with cancer, petitioner was not in a position to obtain pre-authorisation approval from the second respondent in advance for getting treatment in the net