SupremeToday Landscape Ad
Back
Next
Judicial Analysis Court Copy Headnote Facts Arguments Court observation
Listen Audio Icon Pause Audio Icon
judgment-img

2016 Supreme(Mad) 1932

IN THE HIGH COURT OF MADRAS
R. Subbiah, J.
N. Raja – Appellant
Vs.
The Government of Tamil Nadu and Ors. – Respondents
W.P. No. 1408 of 2016 & W.M.P. Nos. 1185, 1186 of 2016
Decided On : 05-04-2016

Advocates Appeared:
For the Appellant : P. Valliappan.
For the Respondent: M. Digvijay Pandian, A.G.P.

Headnote:

Tamil Nadu Medical Attendance Rules - liable to reimburse medical expenses - Not liable to reimbursement amount- It is further case of petitioner that earlier Finance (Salaries) Department issued G.O. Ms introducing a New Health Insurance Scheme for providing health care assistance to employees of Government Departments, Public Sector Undertakings, Statutory Boards Local Bodies State Government Universities Willing State Government with provision to avail assistance up to Rupees Four Lakh and consequently appointed United India Insurance Company Limited which in turn formed respondent – Held, Learned Single Judge of this Court by following decision of Division Bench has given direction to State Government to reimburse the amount - Keeping the said decision court have carefully gone through factual aspects of this case - In instant case also in emergent situation it is not possible for petitioners wife to search for list of network hospital - Under such circumstances above said decision is squarely applicable to present facts of case also - Hence applying above said decision this Court directs respondent to sanction and reimburse medical expenses incurred by petitioner for his treatment with interest from date of remittance of amount to hospital by petitioner till date of payment within a period of four weeks from date of receipt of a copy of this order - Petition Allowed.

ORDER :

R. Subbiah, J.

1. This writ petition has been filed by the petitioner, praying for issuance of a Writ of Certiorarified Mandamus, to call for the records of the 3rd respondent pertaining to its proceedings in Ref. No. GTM 00018/TNNHIS/09/2014, dated 17.09.2014 and to quash the same and consequently, to direct the respondents to reimburse the medical expenses of Rs. 4,18,921/- incurred by the petitioner for taking medical treatment at Apollo Hospital in Tiruchirappali.

2. In the affidavit filed in support of the writ petition, it has been averred by the petitioner as follows:-

2-1. The petitioner is an Adi Dravidar and a native of Thondamadurai Village, Veppanthattai Taluk, Perambalur District. The petitioner has completed B.Sc., B.Ed., in the year 1991. In the year 1997, he joined as Secondary Grade Teacher in a Government Primary School at Ariyalur District. In the year 2009, he was promoted as a B.T. Warden and posted at S.Aduthurai, Kunnam Taluk, Perambalur District. Subsequently, in the year 2012, the petitioner was transferred to Government Boys Hostel, Pasumpalur, Veppathattai Taluk, Perambalur District and till date, he continues to work there as Warden.

2-2. While so, on 16.05.2014 the petitioner suffered a heart attack and immediately, he was rushed to the local government hospital at V.Kalathur. In the said hospital, only first aid was given and the Doctor in the local hospital informed the petitioner's wife that the petitioner should be rushed to a hospital within one hour as otherwise, he would not survive. Hence, the petitioner's wife took the petitioner to the Apollo Hospital at Tiruchirapalli, since it had all the facilities. The petitioner was admitted in Apollo Hospital at Tiruchirapalli and an Angio Blast was performed and two stents were placed on him. Ultimately, he was discharged on 30.05.2014. In the said process, the petitioner incurred a total medical expenses of Rs. 4,18,921/-.

2-3. It is further case of the petitioner that earlier, the Finance (Salaries) Department issued G.O. Ms.No. 243, dated 29th June 2012, introducing a New Health Insurance Scheme, 2012 for providing health care assistance to the employees of Government Departments, Public Sector Undertakings, Statutory Boards, Local Bodies, State Government Universities, Willing State Government with provision to avail assistance upto Rupees Four Lakh and consequently, appointed the United India Insurance Company Limited, Chennai, which in turn formed the 3rd respondent. The petitioner is eligible to get medical assistance under the above scheme.

2-4. After getting discharged from the hospital, the petitioner approached the 3rd respondent with a letter dated 25.08.2015 seeking reimbursement of the amount of medical expenses incurred by him for his treatment. The 3rd respondent, which is a unit of United India Insurance Company, is liable to reimburse the medical expenses as the Insurance premium is being regularly deducted from his salary. However, the 3rd respondent issued a reply dated 17.09.2014, rejecting the request of the petitioner for reimbursement of medical expenses on the ground that he had taken treatment at a non-listed hospital and simply, directed the petitioner to approach the District Level Expert Committee for redressal of grievance.

2-5. It is the case of the petitioner that only due to an emergency, the petitioner was rushed to the nearby Apollo Hospital, which had the facilities to treat him. When he was struggling for his life, his wife cannot be searching for an approved hospital. Hence, the rejection of the petitioner's request for reimbursement of medical expenses cannot be justified. The petitioner is not in a position to bear the huge expenses, which was paid by borrowing money from the friends and relatives. Hence, the petitioner has come forward with the present writ petition before this Court for the relief as stated supra.

3. The respondents 1 & 2 have filed a counter stating that on 29.06.2012, the Government of Tam

















Click Here to Read the rest of this document

1
2
3
4
5
6
7
8
9
10
11
SupremeToday Portrait Ad
supreme today icon
logo-black

An indispensable Tool for Legal Professionals, Endorsed by Various High Court and Judicial Officers

Please visit our Training & Support
Center or Contact Us for assistance

qr

Scan Me!

India’s Legal research and Law Firm App, Download now!

For Daily Legal Updates, Join us on :

whatsapp-icon Back to top