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2024 Supreme(Online)(KER) 20265
HIGH COURT OF KERALA
Murali Purushothaman, J
REMESH.M – Appellant
Versus
STATE OF KERALA – Respondent
WP(C) 26799/2024
The court emphasized the necessity for swift action in addressing grievances under the MEDISEP scheme as mandated by its provisions.
Headnote:
Medical Insurance - Medical Insurance Scheme for State Employees and Pensioners - Clause 9 - The court highlights the importance of timely grievance redressal under the MEDISEP scheme and orders the 4th respondent to consider the petitioner's appeal within two months.
Fact of the Case:
The petitioner, a retiree under the MEDISEP scheme, incurred hospital charges of Rs.96,600 but faced denial of his claim due to pending dues by the hospital, prompting him to seek grievance redressal which was not addressed.
Issues: Whether the petitioner's representation under the MEDISEP scheme was considered timely and appropriately by the relevant authorities.
Ratio Decidendi: The court highlighted that under the MEDISEP scheme's provisions, timely redressal of grievances is essential and must be adhered to by the authorities.
Final Decision: The writ petition is disposed of with directions for timely consideration of the representation.
The petitioner is a retired Government employee and a beneficiary of ' Medical Insurance Scheme for State Employees and Pensioners ' (MEDISEP), a scheme introduced by the Government of Kerala to provide health insurance coverage to its employees, as evident from Ext.P2. On 23.01.2024, the petitioner was admitted in the Aster MIMS Hospital, Kozhikode with posterior circular stroke, bilateral cerebellar infract and dyslipidema and was discharged on 30.01.2024 as evident from Ext.P4 discharge certificate. He had incurred an amount of Rs.96,600/- as hospital charges.
When the petitioner submitted a claim before the 3rd respondent hospital, the same was denied on the ground that huge amount is pending to be paid under the MEDISEP scheme to the hospital. The insurance company has not considered the claim of the petitioner for reimbursement. The petitioner submits that he was given an emergency certificate by the hospital and that in view of the emergency treatment he had undergone, he cannot be denied the benefits under the scheme.
Accordingly, the petitioner has submitted Ext.P7 representation before the 4th respondent committee, constituted for the redressal of the grievances under the MEDISEP scheme. The grievance of the petitioner in this writ petition is that the 4th respondent has not so far considered his representation.
2. Heard the learned counsel for the petitioner, the learned Government Pleader and the learned Standing Counsel for the 2nd respondent insurance company. In the nature of the direction I propose to issue, notice to the 3rd respondent is dispensed with.
3. The learned Standing Counsel for the 2nd respondent submits that Ext.P7 was submitted only on 23.07.2024.
4. Since MEDISEP scheme provides for hierarchy of remedies, there will be a direction to the 4th respondent to consider Ext.P7 representation submitted by the petitioner, treating it as an appeal under Clause 9 of the MEDISEP scheme, as expeditiously as possible, at any rate, within a period of two months from the date of receipt of a copy of this judgment.
The writ petition is disposed of accordingly.
