The right to medical claim cannot be denied solely because the hospital is not included in the government order. The factum of treatment and supporting records certified by doctors/hospitals are crucial for medical reimbursement.

JUDGMENT :

Prayer: Petition filed under Article 226 of the Constitution of India to issue a Writ of Certiorarified Mandamus to call for the records on the file of the first respondent in proceeding No.Oo.Mu.No.60599/KA.B1/3/2016 dated 08.06.2017 and quash the same and consequently directing the respondents to reimburse the medical expenses incurred by the petitioner's husband for a sum of Rs.2,36,851/- to the petitioner.

1. The petitioner has filed this writ petition seeking to quash the order passed by the first respondent dated 08.06.2017 and to direct the respondents to reimburse the medical expenses incurred by her husband for a sum of Rs.2,36,851/- to her.

2. The case of the petitioner is that her husband served as Extension Officer and retired from service on 31.12.1997 on attaining the age of superannuation. He was admitted in Apollo Speciality Hospital, Tiruchirappalli for Gastro Entomology and underwent surgery, however, he died on 04.08.2015. Thereafter, the petitioner made representation to the respondents on 30.09.2016 for reimbursement of the medical expenditure incurred for her husband's treatment at Apollo Speciality Hospital, Tiruchirappalli, which is a non-network hospital. Her claim was rejected vide order of the first respondent, passed in his proceedings No.Oo.Mu.No.60599/KA.B1/3/2016 dated 08.06.2017. Hence, this writ petition.

3. The proposition as to whether the authorities can reject the request of their employees for medical reimbursement of their treatment undertaken, on the ground that the hospital is a non-network / non-scheduled hospital under the Scheme, is no more res integra, in view of the various judicial pronouncements made. One such order passed in W.P.No.34466 of 2019 dated 11.12.2019 has dealt with this aspect, in the following manner:

'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 Head Master of the Panchayat Union School. 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 May 2019, the wife of the petitioner underwent an operation and an emergency surgery was done on 17.05.2019. 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.95,925/-.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 a representation to the first respondent on 17.08.2019 and requested for reimbursement of the hospital expenses incurred by the petitioner. The impugned order came to be passed on 05.09.2019 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 hospital that forms part of the scheme. Aggrieved by the same, the petitioner has approached this Court.

4. Heard Mrs.C.Anandha Ramani, learned counsel appearing on behalf of the petitioner and Mr.A.Zakir Hussain, learned Government Advocate 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