LAWS(MAD)-2010-2-763

STAR HEALTH AND ALLIED INSURANCE CO LTD REP BY ITS PROJECT OFFICER, TAMIL NADU GOVERNMENT EMPLOYEES NEW HEALTH INSURANCE SCHEME Vs. A CHOKKAR AND THE SPECIAL SECRETARY TO GOVERNMENT, FINANCE (SALARIES) DEPARTMENT, GOVERNMENT OF TAMIL NADU

Decided On February 26, 2010
STAR HEALTH AND ALLIED INSURANCE CO LTD REP BY ITS PROJECT OFFICER, TAMIL NADU GOVERNMENT EMPLOYEES NEW HEALTH INSURANCE SCHEME Appellant
V/S
A CHOKKAR AND THE SPECIAL SECRETARY TO GOVERNMENT, FINANCE (SALARIES) DEPARTMENT, GOVERNMENT OF TAMIL NADU Respondents

JUDGEMENT

(1.) The Government of Tamil Nadu received representations from Government Employees regarding their grievances with regard to the existing Tamil Nadu Government Employees Health Fund Scheme, which was implemented by G.O.Ms. No. 18, Finance(Allowances) Department, dated 09.01.1992. Therefore, with a view to address the grievances, the Government decided to implement a new health insurance scheme by G.O.Ms. No. 430, Finance (Salaries) Department, dated 10.09.2007. One of the important features of this scheme was that it would be a cashless facility. The scheme enumerated the list of diseases/treatments and surgeries which would be covered and the scheme also notified the hospitals which would be covered by this Scheme. The beneficiaries were employees of the Government of Tamil Nadu, State Public Sector Undertakings, Local Bodies, State Government Universities and Statutory Boards under the control of the Government of Tamil Nadu. Though initially the scheme covered only the employees of the Government Departments, in the 2007 G.O., it is provided that the Scheme will cover the other employees.

(2.) The issues raised in these writ petitions are the extent to which the insurance company will be bound to indemnify the claims made by the beneficiaries; whether the insurance company and the beneficiaries were bound strictly by the terms of the contract; or whether, notwithstanding the terms of the contract, the insurance company was bound to satisfy all the claims.

(3.) The respondent in Writ Appeal (MD) No. 480/2009 was aggrieved by the rejection of his claim by the insurance company and therefore he filed W.P.(MD) No. ,1091/2009. The learned Single Judge was of the view that the reason given by the appellant/insurance company for rejection of the claim was unsustainable and directed the appellant/insurance company to reconsider the application. Aggrieved by this, the insurance company has filed the writ appeal.