W.P.(MD)No.

25304 of 2018

BEFORE THE MADURAI BENCH OF MADRAS HIGH COURT

DATED : 05.12.2023

CORAM:

THE HONOURABLE MR.JUSTICE S.M.SUBRAMANIAM

AND
THE HONOURABLE MR.JUSTICE V.LAKSHMINARAYANAN

W.P.(MD)No.25304 of 2018
and
W.M.P(MD)No.22916 of 2018

C.Mani ... Petitioner

Vs.

1.Principal Secretary to Government of Tamil Nadu,

Department of Finance (Pension),
Secretariat, Chennai.

2.Director,
Health and Rural Services,
Chennai.

3.Director of Treasuries and Accounts,

Panagal Building,
2nd Floor, Saidapet, Chennai-15.

4.The Principal District Judge,

Pudukkottai.

5.The District Collector,

Pudukkottai District.

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 W.P.(MD)No.25304 of 2018

6.The Treasury Officer,

District Treasury Office,
Pudukkottai.

7.The Divisional Manager,

United India Insurance Company Limited,
Divisional Office-6,
PLA Rathna Towers,
5th Floor, 212, Anna Salai,
Chennai. ...Respondents

PRAYER: Petition filed under Article 226 of the Constitution of India, to issue a
Writ of Certiorarified Mandamus, to call for the records of the 2nd respondent in
O.Mu.No.16704/Kape1/3/2017, dated 02.04.2018 and quash the same as illegal
and arbitrary and in consequence thereof to direct the respondents to sanction and
reimburse medical expenses of Rs.1,24,576/- (Rupees One Lakh Twenty Four
Thousand Five Hundred and Seventy Six Only) for the left radical nephrectomy
with left hydrocele eversion treatment undergone by the petitioner at BRS
Hospital Private Limited, Chennai along with 9% interest till the date of payment.

For Petitioner : Mr.P.Ganapathi Subramanian

For R1 to R6 : Mr.S.Shanmugavel,
Additional Government Pleader
For R7 : Mr.A.Shajahan

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 W.P.(MD)No.25304 of 2018

ORDER

(Order of the Court was made by S.M.SUBRAMANIAM, J.)

The order of rejection to settle the medical reimbursement claim of the

writ petitioner issued by the Director of Health and Rural Services / 2nd

respondent, dated 02.04.2018, is under challenge in the present Writ Petition.

2.The petitioner is a State pensioner and admittedly, a member of

Medical Health Scheme. The petitioner was holding the post of Chief

Administrative Officer in Principal District Court, Pudukkottai and retired from

service on 30.09.2010. He pays subscription under the scheme regularly. The

petitioner had taken treatment as in patient by undergoing surgery for left renal

tumour (Cancer) with effect from 03.04.2016 to 09.04.2016 at BRS Hospital,

Chennai. The petitioner spent a sum of Rs.1,24,576/- (Rupees One Lakh Twenty

Four Thousand Five Hundred and Seventy Six Only) towards medical expenses.

An application was submitted, seeking medical reimbursement. The medical

claim petition of the petitioner was rejected by the 2nd respondent on the ground

that the petitioner undertook treatment in a non-network hospital and therefore, the

petitioner is not eligible for medical reimbursement claim.

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 W.P.(MD)No.25304 of 2018

3.The learned Additional Government Pleader appearing for the

respondents 1 to 6 has made a submission that the medical claim will be settled

only in the event of taking treatment in a network hospital and the hospital, in

which the petitioner took treatment, is not a network hospital and therefore, the

rejection is in order.

4.The learned counsel appearing for the 7th respondent / Insurance

Company has made a submission that the order of rejection was passed by the 2nd

respondent and he supported the grounds raised by the 2nd respondent.

5.The issues regarding the settlement of the medical claim are no more

res-integra in respect of the treatment undertaken in a non-network hospital.

Several orders have been passed by the Courts to settle the medical reimbursement

claim and not to reject the same merely on the ground that the hospital is not

falling under the list of network hospitals.

6.In the present case, the genunity of the treatment taken by the

petitioner has not been disputed. Once the treatment is found to be genuine, there

is no reason to reject the medical claim of the petitioner.

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 W.P.(MD)No.25304 of 2018

7.In view of the facts and circumstances, the impugned order passed by

the 2nd respondent dated 02.04.2018 is set aside. The 7th respondent is directed to

settle the eligible medical reimbursement claim of the petitioner under the scheme

within a period of six (6) weeks from the date of receipt of a copy of this order and

the respondents 1 to 6 shall ensure that the payment is made by the 7th respondent

within the time stipulated by us in this order.

8.With the above direction, this Writ Petition stands allowed. No costs.

Consequently, connected miscellaneous petition is closed.

(S.M.S., J.) & (V.L.N., J.)

05.12.2023

NCC : Yes / No
Index : Yes / No
Internet : Yes / No

Yuva

To
1.Principal Secretary to Government of Tamil Nadu,
Department of Finance (Pension),
Secretariat, Chennai.

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 W.P.(MD)No.25304 of 2018

2.Director,
Health and Rural Services,
Chennai.

3.Director of Treasuries and Accounts,

Panagal Building,
2nd Floor, Saidapet, Chennai-15.

4.The Principal District Judge,

Pudukkottai.

5.The District Collector,

Pudukkottai District.

6.The Treasury Officer,

District Treasury Office,
Pudukkottai.

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 W.P.(MD)No.25304 of 2018

S.M.SUBRAMANIAM, J.
AND
V.LAKSHMINARAYANAN, J.
Yuva

W.P.(MD)No.25304 of 2018

05.12.2023

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