IN THE HIGH COURT OF KERALA AT ERNAKULAM PRESENT THE HONOURABLE MR.JUSTICE BASANT BALAJI FRIDAY, THE 5^TH DAY OF APRIL 2024 / 16TH CHAITHRA, 1946 WP(C) NO. 13903 OF 2024 PETITIONER/S:

VIPINLAL M.K, AGED 26 YEARS S/O. BABU, MEETHALE KUTTIYIL HOUSE, CHERAPURAM.P.0 KAKKATTIL, KOZHIKODE DIST., PIN - 673507 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 LT:D METRO PALACE, NORTH RAILWAY STATION ROAD, ERNAKULAM NORTH, ERNAKULAM., PIN - 682018

3 THE GENERAL MANAGER BADAGARA SAHAKARANA ASUPATHRI LTD VADAKARA P.O. KOZHIKODE DT., PIN - 673101

4 THE GENERAL MANAGER ASTER MIMS HOSPITAL, GOVINDAPURAM P.O. KOZHIKODE DT., PIN - 673016

5 THE CONVENER (DISTRICT COLLECTOR) THE DISTRICT LEVEL GRIEVANCE REDRESSAL COMMITTEE COLLECTORATE, KOZHIKODE THRISSUR DISTRICT., PIN - 673020 OTHER PRESENT:

SC SMT K.S SANTHI, SR GP SMT MARY BEENA JOSEPH THIS WRIT PETITION (CIVIL) HAVING COME UP FOR ADMISSION ON 05.04.2024, THE COURT ON THE SAME DAY DELIVERED THE FOLLOWING:

JUDGMENT

(Dated this the 5^th day of April, 2024)

The petitioner challenges rejection of the MEDISEP reimbursement by the 2^nd respondent Insurance Company. The petitioner joined the MEDISEP scheme with I.D. No.2367558/Policy No. 441200/48/2024/335 (Employer ID 889324) and was regularly paying the monthly subscription without any default. The petitioner’s wife was taken to the 3^rd respondent hospital due to stroke, and was referred to the 4^th respondent hospital in Neurology department and was treated there from 22.11.2023 to 27.11.2023. On discharge of the patient from the 4^th respondent hospital, an amount of Rs.2,96,003/- was paid as hospital bill. The claim for reimbursement was partly allowed and only an amount of Rs.42,800/- was sanctioned by the Insurance company. For reimbursement of the balance amount, the petitioner filed Ext.P8 representation before the 5^th respondent.

2. The counsel for the petitioner submits that a direction may be issued to the 5^th respondent to take up Ext.P8 and pass appropriate orders.

3. In the facts and circumstances of the case and since the petitioner has already approached the 5^th respondent Grievance Redressal Committee with Ext.P8 representation, there will be direction to the 5^th respondent to consider the same, within a period of 2 months from the date of receipt of a copy of this judgment.

With the above direction, the Writ Petition is disposed of.

Sd/-

BASANT BALAJI, JUDGE dl/

APPENDIX OF WP(C) 13903/2024 PETITIONER EXHIBITS Exhibit P1 TRUE COPY OF THE MEDISEP CARD ID NO. 2367558 OF THE PETITIONER DATED NIL Exhibit P2 TRUE COPY THE EMPANELLED PRIVATE HOSPITALS IN KOZHIKODE DISTRICT DATED NIL Exhibit P3 TRUE COPY OF MRI SCAN REPORT DATED 22.11.2023 ISSUED BY THE 3RD RESPONDENT HOSPITAL Exhibit P4 TRUE COPY OF THE DISCHARGE SUMMARY DATED 27.11.2023 ISSUED BY THE 4TH RESPONDENT HOSPITAL Exhibit P5 TRUE COPY OF THE EMERGENCY CERTIFICATE DATED

30.11.2023 ISSUED BY THE 4TH RESPONDENT HOSPITAL Exhibit P6 TRUE COPY OF THE MEDICAL BILL DATED 27.11.2023 ISSUED BY THE 4TH RESPONDENT HOSPITAL Exhibit P7 TRUE COPY OF THE PAYMENT ADVICE DATED 23.02.2024 ISSUED BY THE 2ND RESPONDENT COMPANY TO THE PETITIONER Exhibit P8 TRUE COPY OF THE RELEVANT PAGE OF THE COMPLAINT FILED BY THE PETITIONER BEFORE THE 5TH RESPONDENT COMMITTEE