Emergency medical treatment in a non-network hospital under the New Health Insurance Scheme-2012 warrants reimbursement as per the Tamil Nadu Medical Attendance Rules and court precedents.

This writ petition has been filed praying for issuance of a writ of Certiorarified Mandamus calling for the records relating to the impugned order passed by the 2nd respondent dated 08.01.2015 and to quash the same as illegal and consequentially to direct the respondents 1 and 2 to pay and make good to the petitioner a sum of Rs.44,581/- towards the medical expenses incurred by the petitioner for her son within a time stipulated by this Court.

2. The case of the petitioner, in brief, is as follows:-

The petitioner herein is working as B.T. Assistant in the Corporation Middle School, Madurai. She is covered by the Government of Tamil Nadu, New Health Insurance Scheme-2012 being in the service of the Government of Tamil Nadu. She has been regularly subscribing insurance, for which necessary monthly deductions are made from her salary. On 22.04.2014, the petitioner's minor son Amitesha, aged 10 months, started vomiting continuously without any reason. After administering medicine from the nearby Doctor, the petitioner was under the impression that it was due to food poisoning and the child would get back to stable health. But, on the next day i.e., on 23.04.2014 the health condition of the petitioner's son had gone from bad to worse; therefore, she rushed to nearby Child Specialist in Karthik Hospital at Madurai. On diagnosis, it came to light that it was due to obstructed hernia. The petitioner's son could not take food in the normal course. After through medical check up, the Doctor advised the petitioner that unless her son undertakes surgery immediately for obstructed hernia, it would lead to lot of complications. Therefore, on the advice of the Doctor, the petitioner's son had undergone surgery on the very same day at 04.00 p.m. Since the petitioner was deputed for election duty, due to urgency of the petitioner's son's health condition, the petitioner submitted a representation for cancelling the election duty to the District Collector, Madurai District, on 23.04.2014 explaining the urgency involved. Accordingly, it was accepted by them and she was permitted to be with her son during the course of operation. An operation was also conducted to the petitioner's son at Karthik Hospital at Madurai. In view of the urgency involved, the petitioner could not take prior permission for conducting operation from the Insurance Company. For undergoing an operation, she had incurred an amount of Rs.44,581/- for which she has necessary medical bills and the same were submitted for claim to the 2nd respondent. In this connection, the petitioner has made a detailed representation to all the respondents herein, pursuant to which, the petitioner was called upon by the third respondent to know the genuineness of her claim through his letter dated 02.07.2014. The Joint Director along with the other Doctors examined the medical records at his office and accordingly, issued a genuineness certificate to the petitioner vide letter dated 11.07.2014. Thereafter, the matter was referred to the District Collector for further action. The District Collector, Madurai District has asked the petitioner to appear before him on 12.11.2014. On the said date, in the presence of the officials namely the District Collector, the Insurance Officials and the third respondent herein and Treasury Officials, the petitioner's documents were once again perused by the officials. After satisfying all the relevant records, the District Collector, Madurai District, being the Project Director, has recommended her case to the first respondent herein through his letter dated 25.11.2014 for getting the medical expenses reimbursed. When she was under a bona fide impression that the amount incurred towards her son's medical expenditure will be reimbursed to her, to her shock and surprise, inspite of the fact the insurance officials had accepted her claim before the District Collector, during the meeting held on 12.11.2014, they had rejected her claim vide their letter dated