STATE LEVEL EMPOWERED COMMITTEE Vs. S PARAMASIVAM

JUDGEMENT

(1.) The intra-Court Appeal arises out of the order dated 27.02.2017 passed by Learned Judge of this Court in W.P. (MD) No. 23912 of 2016. The parties are hereinafter referred to as per their description in the Writ Petition for the sake of convenience.

(2.) The Petitioner, who retired as Headmaster, had availed the benefits of the Health Insurance Scheme of the Government of Tamil Nadu by making his contributions towards insurance premia from his pension. As the Petitioner suffered a sudden chest pain on 10.05.2015, he was admitted in G. Kuppusamy Naidu Memorial Hospital at Coimbatore and was diagnosed with cornoary heart disease and advised to undergo open heart surgery for coronoary artery bypass. According to the Petitioner, as there was imminent threat to his life, his family members on the advice of the doctors, consented for the surgery to be performed on 13.05.2015 and after treatment, he was discharged from hospital on 20.05.2015 and has been taking post operative care. The sum of Rs.2,02,086/- charged by the hospital was paid by him apart from additional costs incurred for pre-surgical and post-surgical care. When the Petitioner made a claim for the benefits under the Health Insurance Scheme with the Fifth Respondent, viz., the Treasury Officer, Dindigul, and sought for reimbursement, his case was referred to the Medical Board, which by proceedings in Ref. No. 8198/MB/2015 dated 09.10.2015, had certified the treatment to be genuine and based on the same, the Sixth Respondent, viz., the District Collector, Dindigul, as the head of the District Level Empowered Committee constituted under New Health Insurance Scheme by proceedings in Rc. No. 9376/2015/51 dated 25.12.2015 recommended the claim of the Petitioner for reimbursement with the Seventh Respondent, viz., United India Insurance Company Limited. At that stage, the Fifth Respondent, viz., the Treasury Officer, Dindigul, by communication dated 27.02.2016, enclosed a letter dated 24.02.2016 received from the Seventh Respondent, viz., United India Insurance Company Limited, stating that the Petitioner was not entitled to medical reimbursement as he was treated in a non-network hospital. The Appeal preferred by the Petitioner on 30.03.2016 before the Second Respondent, viz., the Director of Treasuries and Accounts, Chennai, was placed before the First Respondent, viz., the State Level Empowered Committee, Chennai, which by a cryptic order bearing O. Mu. No. 51885/Kape1/3/2016 dated 16.06.2016, reiterated the rejection of the claim as the treatment was taken in a non-network hospital.

(3.) The rejection of the claim of the Petitioner for the medical reimbursement was impugned by the Petitioner in W.P. (MD) No. 23912 of 2016. The Writ Court by order dated 27.02.2017 in that Writ Petition, after referring to the decisions of the Division Benches of this Court in India Healthcare Services (TPA) Limited -vs- K. Parameshwari,2017 MHC 2213 CDJ and N. Raja -vs- Government of Tamil Nadu, 2016 3 CTC 394], held that in cases where the Insurance Company could not be held liable to reimburse the medical expenses incurred for having taken treatment in a non-network hospital, the Pensioner was entitled to his claim to be settled by the State Government under the Tamil Nadu Medical Attendance Rules. Accordingly, the order impugned in the Writ Petition was set aside and direction was issued to the Government of Tamil Nadu to sanction the medical expenses incurred by the Petitioner as per the eligibility criteria in terms of amount under the Scheme along with interest at the rate of 9% per annum without standing on technicalities and release the eligible amount within a period of two months from the date of receipt of copy of this order.