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. 13535 OF 2024 PETITIONER/S:

ROSY M.J AGED 68 YEARS W/O. P.J. THOMAS, PUTHIYA VEETTIL, PERUMPADANNA NORTH PARAVOOR P.O, ERNAKULAM DIST., PIN - 683513 BY ADV ANILKUMAR V. (VAZHARAMBIL)

RESPONDENT/S:

1 THE ADDITIONAL CHIEF SECRETARY (FINANCE- HEALTH INSUR-

ANCE) SECRETARIAT GOVERNMENT OF KERALA THIRUVANANTHAPU-

RAM, 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 DIVINE HOSPITAL (MAX CARE HOSPITAL)

VADAKKANCHERY P.O. THRISSUR, PIN - 680582

4 THE CONVENER (DISTRICT COLLECTOR) THE DISTRICT LEVEL GRIEVANCE REDRESSAL COMMITTEE COLLECTORATE, THRISSUR THRISSUR DISTRICT., PIN - 680003 OTHER PRESENT:

SC SRI. 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 FOL-

LOWING:

JUDGMENT

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

The petitioner challenges rejection of the MEDISEP reimbursement on the ground that the benefit of MEDISEP for knee replacement surgery is only to Government hospitals. The petitioner joined the MEDISEP scheme with I.D. No.1426040/Policy No. 441200/48/2023/336 (Pensioner ID 111070043) and was regularly paying the monthly subscription without any default. The petitioner was admitted in the 3^rd respondent hospital and undergone a surgery for knee replacement. The petitioner has informed the respondent hospital that she had joined MEDISEP, and it is understood that the hospital got pre- authorisation. But, later during discharge, she had to pay Rs.4,30,000/- as hospital bill. The hospital authorities informed the petitioner that as per Ext.P4 Order, knee replacement surgery is available only in Government hospitals. Pointing out these facts, the petitioner filed Ext.P5 representation on 24.5.2023 before the 4^th respondent and prayed for reimbursement of the medical claim.

2. The counsel for the petitioner submits that a direction may be issued to the 4^th respondent to take up Ext.P5 and pass appropriate orders.

3. In the facts and circumstances of the case and since the petitioner has already approached the Grievance Redressal Committee, 4^th respondent with Ext.P5 representation, there will be direction to the 4^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) 13535/2024 PETITIONER EXHIBITS Exhibit P1 TRUE COPY OF THE MEDISEP CARD ID NO.1426040 ISSUED BY THE SUB TREASURY OFFICER PARAVOOR DATED NIL Exhibit P2 TRUE COPY THE EMPANELLED HOSPITALS IN THRISSUR DIS-

TRICT DATED NIL Exhibit P3 TRUE COPY OF THE DISCHARGE SUMMARY DATED 13.03.2023 ISSUED BY THE 3RD RESPONDENT HOSPITAL Exhibit P4 TRUE COPY OF THE G.O (MS)NO. 63/2023 FIN IS PUBLISHED ON 31.03.2023 BY THE 1ST RESPONDENT Exhibit P5 TRUE COPY OF THE COMPLAINT FILED BY THE PETITIONER BEFORE THE 4TH RESPONDENT COMMITTEE DATED 24.05.2023 BY THE 1ST RESPONDENT