ORDER

Heard Mr.B.Prahalad Ravi, Learned Counsel for the Petitioner and Mr.R.Murugan, Learned Additional Government Pleader for the Respondent and perused the materials placed on record apart from the pleadings of the parties.

2. The Petitioner, at the time of filing of this Writ Petition, was working as Grade-I Police Constable in the Police Department and he had made an application dated 07.10.2008 to the Jail Superintendent of the Sub Jail, Sankarankovil, for reimbursement of the medical expenses incurred by him for a surgery relating to varicose vein disease which was forwarded to the Respondent for taking appropriate further action in the matter. In furtherance thereto, the Respondent by letter O.Mu.No.15527/CC2/2008 dated 16.12.2008 informed that 'varicose vein' had not been included in the list of diseases covered to avail the benefits of the Health Insurance Scheme from Star Health and Allied Insurance Company Ltd. In that factual backdrop, the Petitioner has filed this Writ Petition challenging the said order passed by the Respondent and has sought for consequential direction to reimburse with interest the medical expenses that had been incurred by him.

3. It is now trite as held by the Division Bench of this Court in Star Health and Allied Insurance Company Ltd. –vs- A.Chokkkar [(2010) 2 LW 90] that when a claim for medical reimbursement is not covered under the health insurance scheme extended by Star Health and Allied Insurance Company Ltd to the Government Servants, it would have to be processed under Tamil Nadu Medical Attendance Rules by the Head of the Office with the concerned Department in which that employee serves and pay the eligible amount to him.

4. The Hon'ble Supreme Court of India in Shiva Kant Jha -vs- Union of India [2018 (5) MLJ 317], dealing with unfair treatment meted out to Government Servants for medical reimbursement under similar provisions of the Central Government Health Scheme held as follows:-

“13. With a view to provide the medical facility to the retired/serving CGHS beneficiaries, the Government has empanelled a large number of hospitals on CGHS panel, however, the rates charged for such facility shall be only at the CGHS rates and, hence, the same are paid as per the procedure.

Though the Respondent-State has pleaded that the CGHS has to deal with large number of such retired beneficiaries and if the Petitioner is compensated beyond the policy, it would have large ramification as none would follow the procedure to approach the empanelled hospitals and would rather choose private hospital as per their own free will. It cannot be ignored that such private hospitals raise exorbitant bills subjecting the patient to various tests, procedures and treatment which may not be necessary at all times.

14. It is a settled legal position that the Government employee during his life time or after his retirement is entitled to get the benefit of the medical facilities and no fetters can be placed on his rights. It is acceptable to common sense, that ultimate decision as to how a patient should be treated vests only with the Doctor, who is well versed and expert both on academic qualification and experience gained. Very little scope is left to the patient or his relative to decide as to the manner in which the ailment should be treated. Speciality Hospitals are established for treatment of specified ailments and services of Doctors specialized in a discipline are availed by patients only to ensure proper, required and safe treatment. Can it be said that taking treatment in Speciality Hospital by itself would deprive a person to claim reimbursement solely on the ground that the said Hospital is not included in the Government Order. The right to medical claim cannot be denied merely because the name of the hospital is not included in the Government Order. The real test must be the factum of treatment. Before any medical claim is honoured, the authorities are bound to ensure as to whether the Claimant had act