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N.

Suseela vs The Secretary To Government on 16 June, 2014

Madras High Court


N.Suseela vs The Secretary To Government on 16 June, 2014

BEFORE THE MADURAI BENCH OF MADRAS HIGH COURT


DATED:

16.06.2014

CORAM
THE HONOURABLE MR.JUSTICE K.RAVICHANDRABAABU
W.P(MD)No.11595 of 2013
N.Suseela

..Petitioner

Vs

1.The Secretary to Government,


Department of School Education,
Fort.St.George,
Secretariat,
Chennai - 600 009.
2.The Secretary to Government,
Department of Finance(Salaries),
Fort St.George,
Secretariat,
Chennai-600 009.
3.The District Collector,
Tirunelveli District,
Tirunelveli.
4.The Treasury Officer,
District Treasury,
Tirunelveli-9.
5.The Sub-Treasury Officer,
Sub-Treasury Office,
Ambasamudram,
Tirunelveli District.

..Respondents

Prayer
Writ Petition filed under Article 226 of the Constitution of India,
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N.Suseela vs The Secretary To Government on 16 June, 2014

praying this Court to issue a Writ of Certiorarified Mandamus calling for the
records pertaining to the impugned order passed by the fourth respondent in
Na.Ka.1760/2013/G2, dated 11.2.2013 and to quash the same and consequently to
direct the respondents to reimburse the medical expenditure incurred by the
Petitioner.
!For Petitioner :M/s.S.S.Thesygan
^For Respondents :Mr.S.Kumar
Addl.Govt Pleader
:ORDER

The Petitioner is aggrieved against the order passed by the fourth respondent, dated 11.02.2013 and
consequently seeking for a direction to the respondents to reimburse the medical expenses incurred
by the Petitioner.
2.The Petitioner is working as Secondary Grade Teacher. She is a subscriber of Family Health Fund
Scheme. Her daughter suffered with fever on 16.01.2012 and consequently she was given treatment
at Rosemary Hospital at Tirunelveli. The hospital diagnosed that the Petitioner's daughter was
affected with Dengue Fever. She was admitted as an inpatient from 17.01.2012 to 07.03.2012. The
cost of the treatment was assessed by the hospital as Rs.4,16,958/-. The Petitioner paid the entire
amount and submitted the application for medical reimbursement under the above said Health
Insurance Scheme. But the application was returned by stating that treatment undergone was not
listed in the list of diseases and the scheme is a cashless method. Hence the present Writ Petition is
filed for the relief as stated supra.
3.Counter affidavit is filed by the respondents 1 to 4. It is the contention of the respondents that the
disease and treatment involved in this case are not the one listed under the scheme and therefore
the Insurance Company is not bound to honour the claim. However, the learned Additional
Government Pleader submitted that any complaint about the difficulty in availing the benefit shall
be made to the Joint Director of Medical and Rural Health Services Department who in turn will
place the same before the Empowered Committee at District Level constituted by the Government
for taking a decision. Such Empowered Committee is to be headed by the District Collector.
4.The learned counsel for the Petitioner invited this Court's attention to the communication of the
Joint Director of Medical and Rural Health Services Department, Tirunelveli dated 13.08.2012
where he has requested the District Collector at Tirunelveli to constitute a committee for
considering the grievance of the Petitioner. It is further stated by the learned counsel that such
Committee is not constituted so far even after a period of nearly two years.
5. I have heard the learned counsels appearing on either side and perused the New Health Insurance
Scheme Rules, 2007. Rule 10 of the said Rules contemplates of submitting complaints before the
Joint Director of Medical and Rural Health Services Department only when there is any difficulty in
availing treatments, non-availability of facilities, bogus availment of treatment for ineligible
individuals etc. In my considered view, the present case does not fall under anyone of the above
categories and therefore no purpose would be served to remit the matter to the above said
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N.Suseela vs The Secretary To Government on 16 June, 2014

Committee for its action.


6.The Petitioner's claim is rejected only on the ground that Dengue Fever is not a listed disease
under the scheme. The issue as to whether the benefit of reimbursement can be denied on the
ground that a particular hospital is not a listed hospital has been considered by this Court on very
many occasions and it was found that non-inclusion of a particular hospital in the list, where the
treatment was taken place, shall not dis-entitle the claimant from seeking for reimbursement. In
fact, I myself have considered the same issue in W.P(MD)No.8449 of 2014, dated 25.09.2013 by
following the earlier decisions of this Court. Para 6 of the above said order reads as follows:
6.As rightly observed by the learned Single Judge in W.P.No.2714 of 2007(T)(O.A.No.5757 of 2001),
dated 4.11.2011, a person struggling for life or his family members cannot be expected at the golden
hours to search for a recognized hospital to save the life of such person for the immediate medical
facilities. The idea to get the MEDICAL REIMBURSEMENT will not certainly strike in their mind at
that point of time so as to search for hospitals, which are listed by the Government as recognized
institutions. Therefore, if that requirement is expected to be complied with by the ailing person or
his family members, then the object of giving the reimbursement itself would be totally defeated.
Therefore, I am in full agreement with the observations made by the learned Single Judge of this
Court in their respective decisions cited supra. Accordingly, the Writ Petition is allowed and the
impugned order is set aside and the respondents are directed to reimburse the Petitioner the
amount claimed by him within a period of eight weeks from the date of receipt of a copy of this
order. No costs."
7.It is further seen that the above order of this Court is subsequently followed by a learned Single
Judge of this Court in W.P(MD)NO.14585 of 2013 dated 21.1.2014 wherein the learned Judge has
observed in para 5 as follows:
5.As rightly observed by the learned Single Judge in W.P.No.2714 of 2007(T)(O.A.No.5757 of 2001),
dated 4.11.2011, a person struggling for life or his family members cannot be expected at the golden
hours to search for a recognized hospital to save the life of such person for the immediate medical
facilities. The idea to get the MEDICAL REIMBURSEMENT will not certainly strike in their mind at
that point of time so as to search for hospitals, which are listed by the Government as recognized
institutions. Therefore, if that requirement is expected to be complied with by the ailing person or
his family members, then the object of giving the reimbursement itself would be totally defeated.
Therefore, I am in full agreement with the observations made by the learned Single Judge of this
Court in their respective decisions cited supra. Accordingly, the Writ Petition is allowed and the
impugned order is set aside and the respondents are directed to reimburse the Petitioner the
amount claimed by him within a period of eight weeks from the date of receipt of a copy of this
order. In view of the judgement referred to supra, this Writ Petition is allowed and accordingly the
order impugned is set aside and consequently the first respondent is directed to reimburse the
medical expenses pertaining to the Petitioner within a period of eight weeks from the date of receipt
of a copy of this order. No costs. Consequently connected Miscellaneous Petition is closed.

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N.Suseela vs The Secretary To Government on 16 June, 2014

8.Likewise, here the objection is that the particular fever suffered by the Petitioner's daughter is not
a listed disease. In my considered view there cannot be any exhaustive list of diseases or ailments so
as to bring the same under the scheme for extending the benefit. Needless to say that no one knows
as to what ailment or physical sufferance he or she has to undergo or what course of treatment one
has to take for such ailment or sufferance. Equally the framers of the scheme also cannot guarantee
that no one will suffer with any other diseases other than the diseases listed out in the scheme. Nor
they can assure that such non-listed diseases do not require any medical attention or treatment.
Therefore, the list of diseases annexed to the scheme, would be only an illustrative or inclusive one
and certainly not an exhaustive one. It is not the case of the respondents that the Petitioner's
daughter did not suffer the dengue fever nor she took treatment for the same. It is an undisputed
fact that so many people have lost their life by suffering with dengue fever. Therefore if these sort of
technical objections are raised to deny the benefit of the scheme, it would only defeat the object
sought to be achieved rather than to ensure that it reaches the needy persons without any hindrance.
A beneficial scheme aiming the common man's interest and welfare should always be made and
applied as viable and practicable as far as possible. If practical approach is not made and the
authorities are sticking on to their pedantic views based on the terms of the scheme, then this Court
can always lift the veil and find out as to what is the real object which is sought to be achieved.
9.In a decision reported in 2007(2) CTC 494(K.Balswami .vs. Director of Pension, Anna Salai, III
Block, II Floor, Chennai - 600 006 and another), the learned Single Judge has held that the object of
the scheme and policy of the Government is to give financial support to deserving persons who have
contributed to Health Fund Scheme and naturally it is not open to the authorities to suggest the
manner of treatment or to suggest that the treatment should be undergone in a particular hospital
alone which can never be the policy of the Government.
10.Therefore considering all these facts and circumstances, I am of the view that the impugned
order passed against the Petitioner cannot be sustained. Accordingly, the Writ Petition is allowed
and the impugned order is set aside and the respondents are directed to reimburse the medical
expenditure incurred by the Petitioner to the extent as permissible under the rules after ascertaining
the payments made by her to the said hospital. Such exercise shall be done by the respondents 4 and
5 within a period of eight weeks from the date of receipt of a copy of this order.
To
1.The Secretary to Government, Department of School Education, Fort.St.George, Secretariat,
Chennai - 600 009.
2.The Secretary to Government, Department of Finance(Salaries), Fort St.George, Secretariat,
Chennai-600 009.
3.The District Collector, Tirunelveli District, Tirunelveli.
4.The Treasury Officer, District Treasury, Tirunelveli-9.

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N.Suseela vs The Secretary To Government on 16 June, 2014

5.The Sub-Treasury Officer, Sub-Treasury Office, Ambasamudram, Tirunelveli District.

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