Madras High Court
The District Collector vs J.Kanagam on 28 November, 2017
Bench: Indira Banerjee, J.Nisha Banu
BEFORE THE MADURAI BENCH OF MADRAS HIGH COURT DATED: 28.11.2017 CORAM THE HONOURABLE MS.INDIRA BANERJEE, CHIEF JUSTICE AND THE HONOURABLE MRS.JUSTICE J.NISHA BANU W.A.(MD).No.843 of 2017 and CMP No.5757of 2017 1.The District Collector Madurai District, Madurai. 2.The Joint Director Medical and Rural Health Services Department Madurai District Head Quarters, Usilampatty Madurai District 3.The Treasury Officer, District Treasury Madurai. : Appellants Vs. J.Kanagam : Respondent PRAYER: Writ Appeal is filed under Clause 15 of Letters Patent against the order of this Court dated 06.10.2016 in W.P.(MD) No.18935 of 2016. !For Appellants : Mr.V.R.Shanmuganathan ^For Respondent : Mr.S.Govindan :JUDGMENT
[Judgment of the Court was delivered by The Hon'ble Chief Justice] This appeal filed by the State is against the judgment and order dated 06.10.2016 passed by the learned Single Bench setting aside the order impugned in the writ petition and directing the respondents being the appellants herein to reimburse the medical expenses incurred by the respondent/writ petitioner for the treatment of her husband along with 9% interest from the date of remittance of the amount to the hospital by the writ petitioner till the date of payment.
2. The facts giving rise to the writ petition are very briefly narrated hereinafter.
3. The writ petitioner/respondent retired from service as Post Graduate Assistant on 30.04.2017. The writ petitioner/respondent is in receipt of pension. She required to contribute Rs.150/- per month towards Pensioners Health Fund Scheme. This payment is compulsory as per the New Health Insurance Scheme for pensioners. It is not in dispute that the medical benefits under the New Health Insurance Scheme covered the spouse of the pensioner.
4. It appears that the writ petitioner/respondent's husband was admitted to Lakshmana Multi Speciality Hospital on 23.03.2016 and discharged on 01.04.2016. Her claim for medical reimbursement was rejected by the order dated 20.07.2016 impugned in the writ petition, which has been allowed by the order under appeal.
5. From the order under appeal, it appears that the impugned order dated 20.07.2016, had been passed mainly on two grounds. The first ground was that the hospital in which the writ petitioner/respondent's husband had been treated was not an approved hospital under the New Health Insurance Scheme and the second ground was that the writ petitioner/respondent had paid for the expenses, but her entitlement to treatment was under a cashless scheme. The medical facilities of pensioners are governed by various Government orders referred to in the order under appeal.
6. As per the said Government Orders, pensioners, which includes spouses and dependent children of pensioners, who undergo specialized advanced surgeries/treatments in respect of diseases included in the approved list in unaccredited hospitals are also be eligible for sanction of assistance if admitted by reason of urgency for treatment, subject to the satisfaction of the Medical Officer concerned regarding the existence of facilities and infrastructure for the treatment/surgery in the hospital. As per the Government order, the Director of Pension has delegatory powers to sanction pending claims as well as future claims for medical assistance for the pensioners in respect of any eligible treatments as well as eligible treatment taken in unaccredited institutions both within the State as well as outside the State subject to the procedures specified. The procedure, inter alia, is that the Pension Pay Officer/District Treasury Officer/Sub Treasury Officer/Branch Manager of Public Sector Bank, after satisfying himself about the details furnished in the application, shall consult the District Medical Officer attached to the Government Hospitals under the control of Director of Medical and Rural Health Services in the District and the Director of Medical Education in Chennai, as the case may be, who shall certify the existence of facilities and infrastructure for the treatment/surgery undergone in the hospital.
7. In the case of N.Raja v. the State of Tamil Nadu reported in (2006) 3 CTC 394, the contention that the writ petitioner had been treated in a hospital, which was not listed, was not accepted by this Court and the Government was directed to reimburse the amount. In the case of MD India Healthcare Services (TPA) Limited v. K.Parameswari being W.A.(MD) No.1579/2016, a Division Bench of which, one of us (J.Nisha Banu,J.) was member, passed an order dated 16.12.2016 allowing the claim of the husband of the writ petitioner therein.
8. The treatment of the writ petitioner/respondent's husband is not in dispute. In an emergency, a patient may not be in a position to search a network hospital listed out in a Government Order. In any case, there could be no justification in the rejection of a claim on the ground that the writ petitioner had made payment, when, in fact, the Scheme was a cashless one. Payment under compulsion to facilitate treatment cannot possibly be a ground for rejecting a genuine claim to medical reimbursement.
9. We find no grounds to interfere with the order of the learned Single Bench. The writ appeal is dismissed. The interest shall, however, be 6% p.a., and not 9% p.a., as directed by the learned single Bench. No costs. Consequently connected Miscellaneous Petition is closed.
To
1.The District Collector Madurai District, Madurai.
2.The Joint Director Medical and Rural Health Services Department Madurai District Head Quarters, Usilampatty Madurai District
3.The Treasury Officer, District Treasury Madurai..