IN THE HIGH COURT OF KERALA AT ERNAKULAM PRESENT THE HONOURABLE MR. JUSTICE D. K. SINGH THURSDAY, THE

13TH DAY OF FEBRUARY 2025 / 24TH MAGHA, 1946 WP(C) NO. 45530 OF 2024 PETITIONER/S:

SASIKUMAR.V.G.

AGED 54 YEARS S/O.GOPALAN, SUB INSPECTOR OF POLICE, CRIME BRANCH, THRISSUR, RESIDING AT VAISYAPATTU HOUSE, CHANDRA NAGAR, 4TH STREET, MANNUMKAD, THRISSUR, PIN - 680631 BY ADVS.

C.A.CHACKO C.M.CHARISMA BABU V.P.

SHAHBAS AMAN C.M.

RESPONDENT/S:

1 STATE OF KERALA REPRESENTED BY CHIEF SECRETARY, SECRETARIAT, THIRUVANANTHAPURAM, PIN - 695001

2 SECRETARY TO GOVERNMENT FINANCE DEPARTMENT, SECRETARIAT, THIRUVANANTHAPURAM, PIN -

695001

3 STATE NODAL CELL MEDISEP SCHEME, THIRUVANANTHAPURAM, REPRESENTED BY ITS DIRECTOR, PIN - 695023

4 NODAL OFFICER HOME DEPARTMENT, SECRETARIAT, THIRUVANANTHAPURAM, PIN -

695001

5 THE ORIENTAL INSURANCE CO. LTD.

YWCA BUILDING, MG ROAD, THIRUVANANTHAPURAM, REPRESENTED BY ITS PROJECT HEAD-MEDISEP, PIN - 695001

6 PROJECT HEAD - MEDISEP , THE ORIENTAL INSURANCE CO. LTD., YWCA BUILDING, MG ROAD, THIRUVANANTHAPURAM, PIN - 695001

7 ASTER MEDCITY SOUTH CHITTOOR.P.O., CHERANELLOOR, KOCHI, REPRESENTED BY ITS SUPERINTENDENT, PIN - 682027 8 DEPUTY MANAGER - INSURANCE ESI & ECHS, ASTER MEDCITY, SOUTH CHITTOOR.P.O., CHERANELLOOR, KOCHI, PIN - 682027 BY ADVS.

GEORGE A.CHERIAN GEORGE CHERIAN (SR.)(G-81)

ARATHI PRABHAKARAN(K/001158/2022)

THIS WRIT PETITION (CIVIL) HAVING COME UP FOR ADMISSION ON

13.02.2025, THE COURT ON THE SAME DAY DELIVERED THE FOLLOWING:

JUDGMENT The present writ petition has been filed with the following prayers:-

“i) declare the rejection of claim of petitioner under MEDISEP for the surgery and treatment of his wife as illegal;

ii) issue a Writ of Mandamus or any other appropriate writ, order or direction to the respondents 1 to 4 to take emergent steps to approve the claim of petitioner under MEDISEP and reimburse the amount spent by him for the surgery and treatment of his wife;

iii) issue a Writ of Mandamus or any other appropriate writ, order or direction to the 5th respondent to reconsider the claim of petitioner under MEDISEP and reimburse the amount spent by him for the surgery and treatment of his wife forthwith;

iv) issue a Writ of Mandamus or any other appropriate writ, order or direction to the respondents 1 to 5 to consider Ext.P8 representation submitted by the petitioner;

v) petitioner also prays that this Hon’ble Court may be pleased to dispense with production of translation of the document produced in vernacular language; and vi) issue such other reliefs as this Hon’ble Court may deem fit and proper in the facts and circumstances of the case.”

2.The petitioner underwent Coronary Artery Bypass Graft (CABG) open surgery at Aster Medcity Hospital without obtaining prior approval from the MEDISEP authorities. The petitioner’s claim for reimbursement of the bill amount of Aster Medcity for his treatment was denied.

3. This court on the last day of posting of this writ petition i.e., 23.01.2025 passed the following order: -

“Mr. George A. Cherian, learned Standing Counsel accepted notice on behalf of the 5^th respondent who seeks and granted two weeks and no more further time to file counter affidavit. In the counter affidavit it should also be disclosed what is the rate prescribed for heart surgery of the beneficiaries under the MEDISEP Scheme. This Court is of the view that the petitioner would be entitled for reimbursement to that extent from the respondent Insurance Company.”

4.Mr George A Cherian, the learned counsel for the 5^th respondent on instructions submits that under the MEDISEP Scheme maximum amount for CABG is Rs.1,70,500/- and the room charges as per MEDISEP Scheme is Rs.2000/- per month allowable for a period of five days which would come to Rs.10,000/-. Thus, the 5^th respondent is ready to reimburse Rs.1,80,500/- to the petitioner.

5.The learned counsel for the petitioner submits that he will accept the said amount offered by the 5^th respondent Company under the MEDISEP Scheme for his medical reimbursement. 6