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2020 Supreme(Mad) 30
IN THE HIGH COURT OF JUDICATURE AT MADRAS
N. ANAND VENKATESH, J.
K. Mohan – Petitioner
Versus
The Commissioner of Treasuries and Accounts, Chennai and Others – Respondents
W.P. No. 386 of 2020
Decided On : 09-01-2020
Advocate Appeared:
For the Petitioner: R. Manimuthu.
For the Respondent: P.S. Siva Shanmuga Sundaram.
The right to medical claim cannot be denied solely because the hospital is not included in the government order, and the factum of treatment is crucial in determining eligibility for reimbursement.
Headnote:
Medical Reimbursement - Government Employee - New Health Insurance scheme - Shiva Kant Jha vs. Union of India, (2018) 16 SCC 187; Order of the Division Bench of this Court dated 04.02.2019 made in W.A. No. 2749 of 2018 - Tamil Nadu Medical Attendance Rules
Fact of the Case:
The petitioner, a retired Assistant Inspector General of Police, sought medical reimbursement under the New Health Insurance scheme after undergoing an operation. The claim was rejected on the ground that the hospital was not covered under the scheme.
Finding of the Court:
The court found that the medical reimbursement cannot be rejected solely because the operation was done in a hospital not included in the scheme. The court directed the respondent to examine the claim and disburse the reimbursement amount to the petitioner.
Issues: The main issue was the rejection of the medical reimbursement claim based on the hospital not being part of the scheme.
Ratio Decidendi: The court relied on the judgments in Shiva Kant Jha vs. Union of India and Order of the Division Bench of this Court, which established that the right to medical claim cannot be denied solely because the hospital is not included in the government order. The court emphasized the factum of treatment and directed the respondent to disburse the reimbursement amount.
Final Decision: The writ petition was allowed, the impugned order was quashed, and the respondent was directed to examine the claim and disburse the reimbursement amount to the petitioner.
JUDGMENT :
N. ANAND VENKATESH, J.
Prayer: Writ Petition filed under Article 226 of the Constitution of India seeking issuance of Writ of Certiorarified Mandamus calling for the records relating to the impugned order of the 4th respondent herein in proceedings O. Mu. No. 6361/kapi1/3/2019 dated 26.08.2019 and quash the same and consequently, direct the respondents herein to reimburse the medical expenses of Rs. 1,95,921/- (Rupees one lakh ninety five thousand two hundred and ninety one only) with interest at the rate of 9% per annum from 22.09.2017 till the date of reimbursement to the petitioner.
1. This writ petition has been filed challenging the impugned order passed by the 4th respondent rejecting the claim of medical reimbursement made by the petitioner and for a consequential direction to direct the respondents to pay the petitioner the medical reimbursement with interest.
2. It is seen from the records that the petitioner is a retired Assistant Inspector General of Police, in the office of the Director General of Police, Tamil Nadu. The petitioner is a subscriber to the New Health Insurance scheme, which was introduced by the government in the year 2014. The subscription towards the insurance is being deducted regularly from the monthly pension. During September 2017, the petitioner underwent an operation and an emergency surgery was done on 19.09.2017. The petitioner was under the bonafide impression that he is covered by the scheme and he will be getting the medical reimbursement. The Hospital in which the operation was done, gave a final bill for a sum of Rs. 1,95,291/-. The hospital authorities refused to take the medical insurance and left with no other option, the petitioner had to pay the entire bill amount.
3. The petitioner made an Appeal before the first respondent on 14.05.2019 and requested for reimbursement of the hospital expenses incurred by the petitioner. The impugned order came to be passed on 26.08.2019 by the 4th respondent wherein, the medical reimbursement was rejected on the ground that the hospital where the operation was done is not covered under the list of hospitals that forms part of the scheme. Aggrieved by the same, the petitioner has approached this Court.
4. Heard Mr. R. Manimuthu, learned counsel appearing on behalf of the petitioner and Mr. P.S. Siva Shanmuga sundaram, learned Special Government Pleader appearing on behalf of the respondents.
5. The issue that has been raised in this writ petition has already been settled by a series of judgments and the latest judgment on this issue was delivered in W.P. No. 27504 of 2019, dated 17.09.2019. The relevant portion of the judgment is extracted hereunder:-
“4. Learned counsel for the petitioner submitted that amount has been deducted towards medical insurance from the monthly income of the petitioner and therefore, the petitioner is entitled to claim medical reimbursement. However, the same issue came up for consideration in the following judgments, wherein it is held that the pensioner, who underwent treatment in a non network hospital, is also entitled for medical reimbursement.
(i) Shiva Kant Jha vs. Union of India, (2018) 16 SCC 187:
“17. It is a settled legal position that the Government employee during his lifetime or after his retirement is entitled to get the benefit of the medical facilities and no fetters can be placed on his rights. It is acceptable to common sense, that ultimate decision as to how a patient should be treated vests only with the Doctor, who is well versed and expert both on academic qualification and experience gained. Very little scope is left to the patient or his relative to decide as to the manner in which the ailment should be treated. Speciality Hospitals are established for treatment of specified ailments and services of Doctors specialized in a discipline are availed by patients only to ensure proper, required and safe treatment. Can it be said that taking treatment in Speciality Hospital by itself would deprive a
