Madras High Court
T.Mary Roselin vs The State Level Empowered Committee on 21 August, 2020
Author: R.Suresh Kumar
Bench: R.Suresh Kumar
W.P.(MD)No.9820 of 2020
BEFORE THE MADURAI BENCH OF MADRAS HIGH COURT
DATED: 21.08.2020
CORAM:
THE HONOURABLE MR.JUSTICE R.SURESH KUMAR
W.P.(MD)No.9820 of 2020
(Through Video Conferencing)
T.Mary Roselin ... Petitioner
Vs.
1.The State Level Empowered Committee
Represented by its Commissioner,
Medical and Rural Health Services,
DMS Compound,
Chennai.
2.The Principal Secretary/Commissioner,
of Treasuries and Accounts
Integrated Complex for Finance Department
Veterinary Hospital Campus, Nandanam,
Chennai.
3.The Director of Medical and Rural Health Services,
DMS Compound,
Chennai.
4.The District Level Empowered Committee
Represented by the District Collector
Collectorate, Nagercoil.
1/10
http://www.judis.nic.in
W.P.(MD)No.9820 of 2020
5.The Director of School Education,
Collegiate, Nungambakkam,
Chennai.
6.The District Treasury Officer,
Collectorate
Kanyakumari District,
Nagercoil. ... Respondents
PRAYER : Writ Petition is filed under Article 226 of the Constitution of
India to issue a Writ of Certiorarified Mandamus to call for the records
relating to the impugned proceedings dated 05.03.2018 passed by the 1st
respondent as communicated by the 3rd respondent through his proceedings
dated 19.07.2019 in O.Mu.No.33423/Kapi1/3/2019 and quash the same and
further directing the respondents to pay the sum of Rs.1,90,363/- being the
amount towards medical reimbursement with 12% interest from the date of
claim ie., on 10.09.2011 till the date of payment.
For Petitioner :Mr.M.P.Senthil
For Respondents :Mr.G.Arjunan for R1 to R7
ORDER
Challenging the impugned proceedings of the first respondent dated 05.03.2018 communicated by the third respondent dated 19.07.2019 and for a further direction to pay the medical reimbursement with 12% interest, the 2/10 http://www.judis.nic.in W.P.(MD)No.9820 of 2020 petitioner is before this Court with the present writ petition.
2. Heard the learned counsel for the petitioner and the learned Government Advocate for the respondents.
3. The petitioner's medical reimbursement claim was rejected by the order of the third respondent dated 19.07.2019, where, the following reason has been given:
“muR Copah;fSf;fhd Gjpa kUj;Jt fhg;gPl;L jpl;lj;jpd; khepy mstpyhd Nky;KiwaPl;L FO $l;lk; 05.03.2019 md;W Kjd;ik nrayh;/fUT+yk; kw;Wk;
fzf;Fj; Jiw Mizahsh; (khepy mstpyhd mjpfhukspf;fg;gl;l FO $l;l jiyth;) mth;fs;
jiyikapy; cWg;gpdh; nrayh; (DM&RHS)> cWg;gpdh; (Star Health) mth;fSld; eilngw;wJ. ,f;$l;lj;jpy; rkh;g;gpf;fg;gl;l jq;fspd; Nky; KiwaPl;L kD kPJ Kjd;ik nrayh;/fUT+yk; kw;Wk; fzf;Fj; Jiw Mizahsh; (khepy mstpyhd mjpfhukspf;fg;gl;l FO $l;l jiyth;) mth;fshy; KbT VJk; vl;lg;glhky; js;spitf;fg;gl;lJ jw;nghOJ ,izg;gpy; fz;lthW KbT Nkw;nfhs;sg;gl;Ls;sJ vd njhptpj;Jf; nfhs;sg;gLfpwJ. NkYk;> jq;fspd; kUj;Jt Mtzq;fs;
3/10http://www.judis.nic.in W.P.(MD)No.9820 of 2020 (mry;&efy;) ,j;Jld; ,izj;J mDg;gg;gLfpwJ. ,izg;G: khepy mstpyhd FO $l;l Kbtpd; tpguk;.
j.nr.Rthjp nuj;jpdhtjp kUj;Jtk; kw;Wk; Cuf eyg;gzpfs;
,af;Feh;” Challenging the same, the present writ petition has been filed.
4. The learned counsel for the petitioner would submit that, the reason cited in the impugned order insofar as the petitioner is concerned that the treatment was taken in a non networking hospital. Therefore, the reimbursement is not admissible as per the order made in W.P.(MD) No. 1091 of 2009.
5. The learned counsel for the petitioner would submit that, thereafter the issue has been given a quietus and a detailed order has been passed in a batch of Writ Petitions by this Court in W.P.(MD) Nos.13429/2018 etc. batch, by order dated 28.05.2019, in the matter of S.Marimuthu v. State represented by its Secretary and others.
4/10http://www.judis.nic.in W.P.(MD)No.9820 of 2020
6. By citing the said decision, the learned counsel would submit that, the present reason stated in the impugned order therefore, would not be sustained. Hence, the impugned order is liable to be interfered with and suitable direction may be given, he contended.
7. The learned Government Advocate for the respondents would submit that, in view of the latest judgment, the issue can again be placed before the concerned Committee and accordingly, it will be decided.
8. As has been rightly pointed out by the learned counsel for the petitioner, the issue has been settled by a detailed order passed by this Court in the aforesaid batch of cases dated 28.05.2019 in S.Marimuthu v. State, etc., batch, wherein, in the operative portion of the order, this Court has passed the following order:
“80. In order to reconsider all these claim made by the respective writ petitioners for medical reimbursement, by remitting the matters back, the following directions are issued:
(i) All the impugned orders in the respective writ petitions in this batch of cases,are hereby quashed.5/10
http://www.judis.nic.in W.P.(MD)No.9820 of 2020
(ii) The writ petitions where impugned orders are quashed as well as the writ petitions where mandamus sought for, are hereby remanded with directions to the concerned District Level Empowered Committee, before whom, these matters shall be placed and the Committee shall reconsider every individual case.
(iii) While reconsidering, the Committee shall not reject any claim merely on the reason of non network hospital or non listed disease.
(iv) The Committee, wherever possible, shall give suitable direction to the Insurance Company to reimburse the claim made by the respective claimant / employee / pensioner.
(v) If the Committee finds some cases where the Insurance Company cannot be directed to reimburse, in those cases, suitable orders shall be passed directing / recommending the State authorities to reimburse the claim under Medical Attendance Rules.
(vi) Once such orders are passed, the Insurance Company shall immediately reimburse the medical claim with 6% interest from the date of due till date of payment, within a period of thirty days from the date of receipt of such order to be passed by the Empowered Committee of the District concerned.
(vii) On receipt of such orders / recommendation from the Empowered Committee, the Sanctioning authority / State 6/10 http://www.judis.nic.in W.P.(MD)No.9820 of 2020 authority / High Power Committee in the State Level shall pass necessary orders allowing the medical reimbursement claimed by the individual claimant / employee / pensioner under the Medical Attendance Rules.
(viii) While ordering medical reimbursement under Medical Attendance Rules, the rate approved, accepted or quoted by the Insurance Company under the Medical Insurance Scheme shall be taken as the rate and by calculating the reimbursement on the said rate, the reimbursement claim shall be immediately sanctioned and the amount shall be reimbursed to the claimant with 6% interest form the date of due till date of payment, within a period of thirty days from the receipt of the recommendation / order from the District Empowered Committee.
With these directions, all these writ petitions are ordered to the terms indicated above. Consequently, connected miscellaneous petitions are closed. However there shall be no order of costs.”
9. In view of the above, this Court have no hesitation to hold that, the present reason stated by the third respondent in the impugned order cannot be sustained. Therefore, the impugned order is liable to be quashed and 7/10 http://www.judis.nic.in W.P.(MD)No.9820 of 2020 accordingly, quashed and the matter is remitted back to the respondents.
While reconsidering the same, the respondents either shall explore the possibility of giving the medical reimbursement to the petitioner after getting it from the Insurance Company, otherwise, if the contractual obligation between the Government and the Insurance Company is not permitted to give the medical reimbursement for the reason of taking treatment in a non networking hospital, the respondents shall take into account the Medical Attendance Rules as indicated in the aforesaid order and accordingly reimbursing the claim of the petitioner to the extent of its admissibility can be considered and suitable orders can be passed for disbursing the said amount to the petitioner. The needful, as indicated above, shall be undertaken by the respondents within a period of six weeks from the date of receipt of a copy of this order.
10. The writ petition is disposed of with the directions as indicated above. No costs.
21.08.2020
8/10
http://www.judis.nic.in
W.P.(MD)No.9820 of 2020
Index : Yes/No
Internet : Yes
RR
Note: In view of the present lock down owing to COVID-19 pandemic, a web copy of the order may be utilized for official purposes, but, ensuring that the copy of the order that is presented is the correct copy, shall be the responsibility of the advocate/litigant concerned.
To
1.The State Level Empowered Committee Represented by its Commissioner, Medical and Rural Health Services, DMS Compound, Chennai.
2.The Principal Secretary/Commissioner, of Treasuries and Accounts Integrated Complex for Finance Department Veterinary Hospital Campus, Nandanam, Chennai.
3.The Director of Medical and Rural Health Services, DMS Compound, Chennai.
4.The District Level Empowered Committee Represented by the District Collector Collectorate, Nagercoil.
5.The Director of School Education, Collegiate,Nungambakkam, Chennai.
6.The District Treasury Officer, 9/10 http://www.judis.nic.in W.P.(MD)No.9820 of 2020 Collectorate Kanyakumari District, Nagercoil.
R.SURESH KUMAR, J.
RR W.P.(MD)No.9820 of 2020 21.08.2020 10/10 http://www.judis.nic.in