2019 Supreme(Mad) 3412
IN THE HIGH COURT OF MADRAS
K.K. Sasidharan and P.D. Audikesavalu, JJ.
United India Insurance Co. Ltd. - Appellant
Versus
A.N. Natharsha and Ors. - Respondent
W.A. No. 2076 of 2018 and C.M.P. No. 16352 of 2018
Decided On : 27-03-2019
For the Appellant : T. Shanmugam
For the Respondent: A. Sri Jayanthi, Special Government Pleader
Headnote:
New Health Insurance Scheme, 2014 - Tamil Nadu Medical Attendance Rules - Service matter - Governmental Order - Pensioners (including spouse)/Family Pensioners - Claim for reimbursement - Order passed by Third Respondent and directed Respondents to settle claim for medical reimbursement made by Petitioner, that order granting liberty to Fourth Respondent to recover same from First to Third Respondents in terms of conditions of agreement with Government - Hence this appeal - Held, It is a settled legal position that Government employee during his life time or after his retirement is entitled to get benefit of medical facilities and no fetters can be placed on his rights - Though that Governmental Order has been issued after claim has been made in this case, aforesaid guidelines, which are based upon instructions provided in earlier Government orders and Tamil Nadu Medical Attendance Rules, are obviously clarificatory in nature and would apply to past cases as well - Since Petitioner had taken treatment at Hospital, Fourth Respondent cannot be held liable for medical reimbursement under New Health Insurance Scheme and conclusion of Writ Court to that extent cannot be sustained - Writ Appeal is disposed of
JUDGMENT :
P.D. Audikesavalu, J.
1. The intra-Court Appeal arises out of the order dated 15.09.2017 in W.P. No. 22529 of 2016 passed by the Learned Judge of this Court. The parties are hereinafter referred to as per their description in the Writ Petition for the sake of convenience.
2. The Petitioner, who retired as Senior Civil Surgeon from the Department of Medical Service, Chennai in the year 1999, had opted to avail the benefits of the New Health Insurance Scheme, 2014 for Pensioners (including spouse)/Family Pensioners as per G.O. Ms. No. 462, Finance (Pension) Department dated 27.12.2013 issued by the Government of Tamil Nadu to provide health care assistance to the Pensioners (including spouse)/Family Pensioner on a cashless basis, with provisions to avail assistance up to Rs. 2,00,000/- for a block period of four years, by making his contributions towards insurance premia from his pension. The wife of the Petitioner suddenly fell ill and on diagnosing her, she was advised to undergo immediate surgery and the Petitioner admitted his wife at Vedanayagam Hospital Limited, Coimbatore on 08.10.2014 and renal surgery had been done on her on 09.10.2014. When the Petitioner filed his claim before the Third Respondent, the same was placed before the District Empowered Committee headed by the District Collector on 13.03.2015 and the said Committee approved the claim for reimbursement of the sum of Rs. 60,000/- spent for surgery. The Third Respondent has thereafter forwarded the claim of the Petitioner to the Fourth Respondent/Insurance Company and intimated the same to the Petitioner on 08.02.2016. According to the Petitioner, the Fourth Respondent/Insurance Company has returned the claim of the Petitioner stating that the Hospital in which the treatment has been taken is not a listed Hospital, which has been informed to him by proceedings Na. Ka. No. 1491/2016/E2 dated 23.03.2016 and Na. Ka. No. 8927/2014/E2 dated 25.05.2016. The Petitioner then made a representation dated 23.05.2016 to the First to Third Respondents and there was no reply for the same.
3. In that factual backdrop, the Petitioner had filed W.P. No. 22529 of 2016 before this Court challenging the orders Na. Ka. No. 1491/2016/E2 dated 23.03.2016 and Na. Ka. No. 8927/2014/E2 dated 25.05.2016 passed by the Third Respondent rejecting his claim petition for medical reimbursement and had sought for consequential direction to the Respondents to disburse with the approved medical expenses amount under New Health Scheme, 2014 for pensioners (including spouse)/family pensioners as recommended by the District Executive Committee headed by the District Committee on 24.04.2015 to the Petitioner. The Writ Court by order dated 15.09.2017 allowed the Writ Petition by quashing the orders Na. Ka. No. 1491/2016/E2 dated 23.03.2016 and Na. Ka. No. 8927/2014/E2 dated 25.05.2016 passed by the Third Respondent and directed the Respondents to settle the claim for medical reimbursement made by the Petitioner, within a period of four weeks from the date of receipt of copy of that order, granting liberty to the Fourth Respondent to recover the same from the First to Third Respondents in terms of the conditions of the agreement with the Government. Aggrieved thereby, the Fourth Respondent has preferred this appeal.
4. Despite service of notice, the Petitioner has not appeared in person or through Counsel. We have heard Mr. T. Shanmugam, Learned Counsel appearing for the Fourth Respondent, Mrs. A. Sri Jayanthi, Learned Special Government Pleader appearing on behalf of the First to Third Respondents and perused the materials placed on record, apart from the pleadings of the parties.
5. It is strenuously urged by the Learned Counsel for the Fourth Respondent that the Writ Court ought not to have fastened any liability on the Fourth Respondent/Insurance Company when it was not liable under the New Health Insurance Scheme in view of the decision the Division Bench of this Court in Star Health and All