Dependents of deceased government employees are entitled to reimbursement of medical expenses incurred, regardless of insurance coverage withdrawal due to death before surgery.

ORDER :

(C. SARAVANAN, J.)

In the present writ petition, the petitioner has challenged the G.O.(Rt.)No.384, Labour and Employment (OP2-1) Department dated 31.12.2013 passed by the 1^st respondent. By the impugned order, the claim of the petitioner for reimbursement of medical expenses incurred for the treatment of her husband (deceased) has been rejected.

2. The brief facts of the case are that the petitioner's husband G.Bhagirath was working as an Under Secretary to Government in the 1^st respondent Department. Due to chest pain, he was admitted at Sri Ramachandra Medical Centre, Porur for treatment on 03.07.2009 where angiogram was performed on him which revealed the blocks in his blood vessels. Hence, he was advised stent operation and Bye-Pass surgery.

3. Thus, stent operation was performed on the petitioner's husband on 03.07.2009 and he was therefore kept under observation in ICU prior to the Bye-Pass surgery. However, even before the Bye-Pass surgery could be performed, the petitioner's husband died on 04.07.2009. Thereafter, the Hospital authorities informed the petitioner that the Insurance Coverage is withdrawn as her husband had died even before the Bye-Pass surgery.

4. Hence, the petitioner was asked to pay a sum of Rs.1,66,551/- towards the medical treatment of her husband. The said amount was also paid by the petitioner.

5. The petitioner thus sent a representation dated 21.10.2009 to the Star Health & Allied Insurance Company Limited, for reimbursement of Rs.1,66,551/- paid by her towards the medical treatment of her husband. However, the General Manager of said Insurance Company vide Letter bearing Ref: File No. R-2648 dated 09.11.2009, rejected the petitioner's claim.

6. Thereafter, the petitioner filed a writ petition in W.P.No.23762 of 2009 before this Court seeking to quash the Letter dated 09.11.2009 of Star Health & Allied Insurance Company Limited and to direct the General Manager of Star Health & Allied Insurance Company Limited to settle her claim of Rs.1,66,551/- or direct the respondents 2 to 4 therein to pay a sum of Rs.1,66,551/- being the amount spent towards medical treatment of her deceased husband.

7. The Madurai Bench of this Court in Star Health & Allied Insurance Vs. A.Chokkar & Anr. reported in (2010) 2 L.W. 90 held that the claimants are not remediless. It held that they can claim reimbursement from the Government under the Tamil Nadu Legislative Assembly (Medical Attendance and Treatment) Rules , 1964.

8. This Court vide its order dated 30.03.2010, disposed of W.P.No.23762 of 2009 with the following observation:

“8. In view of the said submission, the writ petition is disposed of granting liberty to the petitioner to approach the fifth respondent, within a period of two weeks from the date of receipt of a copy of this order and the fifth respondent is directed to consider the request of the petitioner and pass necessary orders, in accordance with the Division Bench Judgment, within a period of four weeks thereafter. No costs.”

9. Pursuant to the above order of this Court, the petitioner made a representation dated 14.04.2010 to the 1^st respondent herein, seeking to settle her claim of Rs.1,66,551/-. However, the 1^st respondent vide impugned order dated 31.12.2013, allowed the petitioner's claim for a limited sum of Rs.39,981/-. Hence, the petitioner has knocked the doors of this Court with the present writ petition.

10. The learned counsel for the petitioner submitted that the 1^st respondent has passed the impugned order dated 31.12.2013 and restricted the amount to the probable expenses that would have been incurred, had the petitioner's husband taken the same treatment at Rajiv Gandhi Government Hospital, Chennai as a paying patient and in terms of G.O.Ms.No.1023 / Health & Family Welfare Department dated 17.06.1980. He further submitted that the actual medical expenses incurred by the petitioner for treatment of her husband is Rs.1,66,551/-. However, the 1^st respondent has only sanctioned a meager