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2017 Supreme(Mad) 3675
BEFORE THE MADURAI BENCH OF MADRAS HIGH COURT
M. VENUGOPAL, ABDUL QUDDHOSE, JJ.
The Director of Pension & Others - Appellants
Versus
B. Sarada - Respondent
W.A.(MD) No. 1382 of 2017 & C.M.P.(MD). No. 9879 of 2017
Decided On : 09-11-2017
For the Appellants : V.R. Shanmuganathan, Special Government Pleader.
For the Respondent:S. Govindan, Advocate.
Headnote:
Writ Appeal - Medical Reimbursement - Tamil Nadu Medical Attendance Rules, 1995, G.O.Ms.No.171, Finance (Pension) Department, dated 26.06.2014, G.O.Ms.No.458, Finance (Pension) Department, dated 21.09.2007, G.O.Ms.No.475, Finance (Pension) Department, dated 30.09.2009, G.O.Ms.No.477, Finance (Pension) Department, dated 30.09.2009, G.O.Ms.No.139, Finance (Salaries) Department, dated 27.04.2012, G.O.Ms.No. 243, Finance (Salaries) Department, dated 29.06.2012, G.O.Ms.No.462, Finance (Pension) Department, dated 27.12.2013, G.O.Ms.No. 171, Finance (Pension) Department, dated 26.06.2014, G.O.Ms.No.202, Finance (Salaries) Department, dated 30.06.2016, G.O.Ms.No.241, Finance (Salaries) Department, dated 24.08.2016 - The court analyzed various government orders and rules related to medical reimbursement for pensioners and employees, emphasizing the obligation of the state government to provide health care assistance and bear the expenses incurred by the government servant for treatment, irrespective of the hospital's accreditation status. The court also highlighted the constitutional duty of the state to raise the level of nutrition, standard of living, and improve public health, and the right to health as an integral part of the right to life.
Fact of the Case:
The Respondent, a pensioner's wife, sought reimbursement for medical expenses incurred for her husband's treatment at an unapproved hospital, which was rejected by the District Treasury Officer. The Learned Single Judge allowed the Writ Petition, directing the First Appellant to sanction the medical expenses.
Finding of the Court:
The court found that the state government is obligated to provide health care assistance and bear the expenses incurred by the government servant for treatment, regardless of the hospital's accreditation status. It emphasized the constitutional duty of the state to raise the level of nutrition, standard of living, and improve public health, and the right to health as an integral part of the right to life.
Issues: The issues revolved around the rejection of medical reimbursement for treatment at an unapproved hospital and the obligation of the state government to provide health care assistance and bear the expenses incurred by the government servant for treatment.
Ratio Decidendi: The court's decision was based on the interpretation of various government orders and rules related to medical reimbursement, emphasizing the obligation of the state government to provide health care assistance and bear the expenses incurred by the government servant for treatment, irrespective of the hospital's accreditation status, and the constitutional duty of the state to raise the level of nutrition, standard of living, and improve public health.
Final Decision: The court directed the Appellant to sanction the medical expenses incurred by the Respondent's wife, as per the eligibility criteria, along with interest at 6% p.a., and release the eligible sum within a period of four weeks.
M. Venugopal, J.
1. The Appellants/Respondents have preferred the present Writ Appeal, as 'Aggrieved Persons', against the order, dated 27.02.2017 in W.P.(MD) No.125 of 2017, passed by the Learned Single Judge.
2. The Learned Single Judge, while passing the impugned order in W.P.(MD)No.125 of 2017 filed by the Respondent (as Writ Petitioner) at paragraph Nos.7 and 8, had observed the following:-
"7. Admittedly, the Petitioner has taken treatment in a non-network Hospital on account of emergent situation, which ultimately resulted in rejection of her claim. Subsequently, the High Level Committee has also rejected the claim of the Petitioner. It is not in dispute that if the claim is approved, the Petitioner would be paid the medical benefits based on Tamil Nadu Medical Attendance Rules (in short “the Rules”). The benefit of scheme, namely, the contract cannot be rewritten and it is only the Government to pay the amount incurred by the Petitioner/Employee/ patient/pensioner irrespective of constitution of the Committee. It is pertinent to mention here that the patient cannot search for network Hospital for getting admitted or for taking treatment during emergency.
8. This Court in the case of N. Raja vs. The Government of Tamil Nadu, rep. by its Secretary, Chennai and others, reported in 2016 (3) CTC 394, has clearly held that when the Insurance Company is not liable on account of the violation of the terms and conditions of the contract, it is the duty of the Government to reimburse the medical expenses incurred. The Hon'ble Division Bench of this Court also, by order dated 16.12.2016 in W.A.(MD) No.1579 of 2016 [MD India Healthcare Services (TPA) Ltd., rep. by the Branch Manager, Chennai, Chennai vs. K. Parameshwari and others], directed the Government to reimburse the medical expenditure. In view of the above, this Court is of the view that pursuant to the existence of the contract, the Insurance Company cannot be directed to pay the amount and therefore, it is the Government, which is liable to reimburse the amount." and consequently, allowed the Writ Petition.
3. Continuing further, the Learned Single Judge while allowing the Writ Petition at paragraph Nos.9 and 10 of the order, had directed the First Respondent (First Appellant in Writ Appeal) to sanction the medical expenses incurred by the Respondent/Petitioner (Pensioner), as per the eligibility criteria in terms of the amount under the scheme together with interest at 9% p.a. without standing on technicalities and release the eligible amount within a period of two months from the date of receipt of a copy of the order.
4. Challenging the order dated 27.02.2017 in allowing the Writ Petition, by the Learned Single Judge, the Appellants/Respondents have filed the present intra-Court Writ Appeal by taking a plea that the order of the Learned Single Judge in directing the First Appellant/First Respondent to sanction the medical expenses incurred by the Respondent/Petitioner/Employee's wife, as per eligible criteria in terms of the amount under the scheme along with interest at 9% p.a. etc., is not justifiable either in law or on facts and circumstances of the case.
5. The Learned Special Government Pleader for the Appellants proceeds to point out that the Respondent/Petitioner's husband was a retired Teacher, who underwent a surgery in his hip on 22.07.2015 in an 'Unapproved Hospital' and was not 'Cashless' treatment. Subsequently, he expired on 08.04.2016 and that the Respondent/Petitioner (as wife) made a claim of medical reimbursement of Rs.1,07,690/- and that she filed W.P. (MD) No.21349 of 2015 seeking Mandamus and on 01.02.2015, directions were issued to consider her request. On behalf of the Appellants, it is brought to the notice of this Court that by an order, dated 07.11.2016, the District Treasury Officer, Madurai rejected the claim on the score that the treatment was in an 'Unapproved Hospital' and was not 'Cashless' treatment. The said proceedings of the Dis
