The court established that the rejection of medical reimbursement based solely on a medical officer's opinion was unsustainable and that the petitioner's decision to undergo surgery was justified.

JUDGMENT

(Prayer:Writ Petition filed under Article 226 of Constitution of India, praying for issuance of Writ of Certiorarified Mandamus calling for the records in ref.No.A-2/964-19/H dated 19.07.2019 passed by the second respondent and ref.No.A-2/7275/18/H dated 20.11.2018 passed by the third respondent and quash the same and consequently direct the respondents herein to pay the reimbursement of the medical expenses of Rs.2,76,605/- to the petitioner.)

1. This writ petition has been filed by the petitioner seeking to call for the records in ref.No.A-2/964-19/H dated 19.07.2019 passed by the second respondent and ref.No.A-2/7275/18/H dated 20.11.2018 passed by the third respondent and quash the same and consequently direct the respondents herein to pay the reimbursement of the medical expenses of Rs.2,76,605/- to the petitioner.

2. Learned counsel for the petitioner submitted that the petitioner has worked as a Chief Store Supervisor in Medical Department, Chennai Port Trust for 37 years and retired from his service on 31.05.2015. After his retirement, he was paid one time lumpsum contribution for medical treatment of Rs.50,440/- vide chellan No.830 dated 03.06.2015. This being so, the petitioner had severe abdominal pain and got admitted in Apollo Speciality Hospital, Teynampet, Chennai on 25.09.2018. The hospital authorities diagnosed his condition as Inflammatory Myofibroblastic Tumour and on the advice of the Medical Officer of the said hospital, the petitioner underwent surgery of Laparotomy Excision of Sarcoma and Right Hemicolectomy on 26.09.2018 as inpatient and discharged on 02.10.2018. For the said treatment, he has spent an expenses of a total sum of Rs.2,76,605/-.

3. Learned counsel for the petitioner further submitted that the petitioner sent a representation to the third respondent on 31.10.2018 along with medical bills and discharge summary issued by the hospital authority, requesting the third respondent for reimbursement of medical expenses. After receiving the said representation, the third respondent has sent a rejection letter on 20.11.2018 stating that “it is informed that your claim for reimbursement of Apollo Cancer Institute, Chennai-600 035 expenses shall not be entitled as per Chennai Port Trust Medical Officers opinion”. Hence, the petitioner preferred an appeal before the first respondent on 02.02.2019, requesting him to pay Rs.2,76,605/- as claimed in reimbursement petition. On 07.08.2019, the office of the second respondent sent a communication to the petitioner stating that production of the original bills related to claim are available in A-2 Section, Medical Department and the same may be collected in person or through an authority representative with a copy of medical identity card and authorization letter signed by the claimant during the office hours within 15 days from the date of the receipt of the letter. As per the said letter, the petitioner has produced entire bills, discharge summary and identity card before the first respondent office.

4. However, the second respondent on 19.07.2019, rejected the petitioner''s request and communicated the same in proceedings No.A- 2/964/19/H stating that as per Chief Medical Officer''s instruction, Dr.C.Anita, Sr.Medical Officer has reviewed the claim and opined that “the discharge summary of the said patient has been carefully scrutinized. It is found that the said patient is a case of Myofibroblastic Tumour since 2004. He is also on periodic annual follow up. He was diagnosed to have a recurrence of the disease pathology during his annual check and planned for an “Elective surgery” at Apollo Hospital. Hence Inflammatory Myofibroblastic Tumour” cannot be considered as an emergency for surgical intervention. Hence, retired employee cannot be considered for reimbursement and further his representation also cannot be entertained”. Aggrieved over the rejection orders dated 20.11.2018 & 19.07.2019, passed by the second and third respondent, the petitioner has