IN THE HIGH COURT OF KERALA AT ERNAKULAM PRESENT THE HONOURABLE MR.JUSTICE BASANT BALAJI TUESDAY, THE 6^TH DAY OF FEBRUARY 2024 / 17TH MAGHA, 1945 WP(C) NO. 1523 OF 2024 PETITIONER/S:

VIMALA.G., AGED 67 YEARS, W/O. KESHAVAN EMBRANTHIRI, THALAKULAM ILLAM KOLAKKATTUCHALI, CHELEMBRA, MALAPPUARM DISTRICT., PIN - 673634 BY ADV ANILKUMAR V. (VAZHARAMBIL)

RESPONDENT/S:

1 THE ADDITIONAL CHIEF SECRETARY (FINANCE- HEALTH INSURANCE) SECRETARIAT, GOVERNMENT OF KERALA THIRUVANANTHAPURAM, KERALA., PIN - 695001

2 THE REGIONAL MANAGER, THE ORIENTAL INSURANCE COMPANY LTD METRO PALACE, NORTH RAILWAY STATION ROAD, ERNAKULAM NORTH, ERNAKULAM, PIN - 682018

3 THE GENERAL MANAGER, MEITRA HOSPITAL, KARAPARAMBA KUNDUPARAMBA, MINI BYE PASS RAOD. KOZHIKODE, PIN -

673005

4 THE CONVENER (DISTRICT COLLECTOR) DISTRICT LEVEL GRIEVANCE REDRESSAL COMMITTEE COLLECTORATE, KOZHIKODE KOZHIKEDE DISTRICT, PIN - 673001 BY ADVS. GEORGE A.CHERIAN (SR.), JAISON MATHEW(K/002873/2023), SMT.K.S.SANTHI, SC FOR R2 OTHER PRESENT:

SR GP SMT MARY BEENA JOSEPH.

THIS WRIT PETITION (CIVIL) HAVING COME UP FOR ADMISSION ON 06.02.2024, THE COURT ON THE SAME DAY DELIVERED THE FOLLOWING:

JUDGMENT

(Dated this the 6^th day of February, 2024)

The Writ Petition is filed seeking a direction or order to the 4^th respondent committee to consider the Ext.P7 representation of the petitioner, in a time bound manner.

2. The petitioner was a State Government employee and after her retirement she has joined in ‘MEDISEP’ scheme and regularly paying monthly subscription without any default. Her husband is also included under the said scheme. Being so, her husband was admitted in the 3^rd respondent empanelled Hospital on 03.05.2023, due to Tricompartmental Stage IV osteoarthritis bilateral knee and on 07.05.2023 he was discharged with bilateral total knee replacement. The petitioner applied for MEDISEP coverage through the said hospital. The petitioner paid an amount of Rs.4,45,213/-. The petitioner received a reply from the Oriental Insurance Company Limited that on scrutiny of claim documents, the clam is not admissible as MEDISEP is a cashless scheme and no reimbursement is allowed other than emergency cases. As the treatment done does not come under scope of emergency treatment, the claim is not entertained.

3. The 3rd respondent hospital is an empanelled one with MEDISEP and knee replacement is fully covered with MEDISEP as per Ext.P6. Pointing out the grievance regarding the rejection of the claim, the petitioner filed Ext.P7 before the 4th respondent on 21.12.2023. The petitioner prays that a direction be given to the 4th respondent to pass orders on Ext.P7 within a time frame.

Having heard the counsel on both sides, I am of the considered opinion that since Ext.P7 is pending before the 4th respondent without any orders, there will be a direction to the 4^th respondent to take up Ext.P7 and pass appropriate orders within a period of 2 months from the date of receipt of a copy of this judgment.

Writ Petition disposed of.

Sd/-

BASANT BALAJI JUDGE dl/

APPENDIX OF WP(C) 1523/2024 PETITIONER EXHIBITS Exhibit P1 TRUE COPY OF THE MEDISEP CARD OF THE PETITIONER BEARING NO.1175539 DATED NIL ISSUED BY THE SUB TREASURY FEROK Exhibit P2 TRUE COPY OF THE LIST OF EMPANELLED HOSPITALS, KOZHIKODE DISTRICT WITH MEDISEP Exhibit P3 TRUE COPY OF THE RELEVANT PAGE OF DISCHARGE SUMMARY DATED 07.05.2023 ISSUED BY THE 3RD RESPONDENT HOSPITAL Exhibit P4 TRUE COPY OF THE MEDICAL BILL DATED 07.05.2023 ISSUED BY THE 3RD RESPONDENT HOSPITAL Exhibit P5 TRUE COPY OF THE REJECTION LETTER DATED

10.07.2023 ISSUED BY THE 2ND RESPONDENT Exhibit P6 TRUE COPY OF THE RELEVANT PAGES OF NOTIFICATION GO (P) NO. 70/2022/FIN DATED 23.06.2022 ISSUED BY THE 1ST RESPONDENT Exhibit P7 TRUE COPY OF THE REPRESENTATION DATED 21.12.2023 SUBMITTED BEFORE THE 4TH RESPONDENT COMMITTEE