SECRETARY TO GOVERNMENT Vs. PAUL JEYAKUMAR

JUDGEMENT

(1.) The official respondents in W.P.(MD) No.7168 of 2015 are the appellants. The petitioner/first respondent was working as a Headmaster and on 03.12.2014, he developed a severe chest pain and was immediately taken to Meenakshi Mission Hospital and Research Centre, Madurai and was admitted as an inpatient. On the date of the admission of the petitioner in the said hospital, Coronary Angiogram was done and triple vessel coronary disease was diagnosed. The petitioner thereafter, on the advice of his family Doctor was admitted at G.Kuppusamy Naidu Memorial Hospital, Coimbatore as an inpatient and was given advice to undergo "Coronary By-pass Surgery". Since the procedure in the coronary surgery has to be done emergently and due to insistance in the said hospital, the wife of the petitioner had remitted a sum of Rs.1,00,000/- (Rupees One Lakh only) and Rs.96,000/- (Rupees Ninety Six Thousand only) on 13.12.2014 and 14.12.2014 respectively and the petitioner underwent the Coronary Artery Bypass Graft Surgery successfully on 15.12.2014 and was discharged on 22.12.2014.

(2.) It is the case of the petitioner that the procedure namely Coronary Artery Bypass Graft Surgery was one of the approved treatment under the Annexure-II of the scheme and the hospital in which he has undergone the said treatment is also accredited hospital under the Annexure-II as per the New Health Insurance Scheme and under the said impression, the petitioner had submitted an application dated 20.03.2015 to the third appellant claiming the reimbursement of Rs.1,96,000/- spent for surgery and treatment in the said hospital. However, to the shock and surprise of the first respondent/writ petitioner, the said application was rejected vide proceedings dated 25.03.2015 observing that he ought to have underwent the treatment in the approved hospital and in the absense of the same, he should bear the expenses. The petitioner challenging the legality of the said order has filed the writ petition and it was entertained.

(3.) The third respondent has filed a counter affidavit and took a stand that the Government of Tamil Nadu has implemented a New Health Insurance Scheme, 2012 vide G.O.Ms.No.243, Finance (Salaries) Department dated 29.06.2012 and as per the paragraph No.11 of the said Government Order, the scheme is treated as "cashless scheme" and therefore, the petitioner should have followed the procedure contemplated in the said paragraph, however, the wife of the first respondent/writ petitioner had remitted the treatment charges to the hospital in deviation to the scheme and in the light of the observation stated in the Annexure-II of the scheme, any claim in deviation of the scheme is to be rejected and therefore, took a stand that the impugned proceedings of the third respondent are perfectly in order and prays for dismissal of the writ petition.