Disposed

Sajan T Sunny v. the State of Kerala

Kerala HC16 Nov 2023WP(C)/29689/2023

Case brief

AI extract

What is this about?

Petitioner, a pensioner with Parkinson's, sought cashless Deep Brain Stimulation surgery at Aster Medcity under the MEDISEP scheme but was rejected for non-empanelment. The High Court, finding the grievance pending before the District Authority, issued directions for its disposal within 30 days.

What did the court decide?

Directions issued to the District Level Grievance Redressal Committee to hear the petitioner's grievance and decide it within thirty days.

Sajan T Sunny Vs the State of Kerala — Consumer Protection | Kerala HC (2023)

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IN THE HIGH COURT OF KERALA AT ERNAKULAM

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PRESENT

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THE HONOURABLE MR. JUSTICE RAJA VIJAYARAGHAVAN V

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THURSDAY,THE16THDAYOFNOVEMBER2023/25THKARTHIKA,1945

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WP(C)NO.29689OF2023

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PETITIONER:

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SAJANTSUNNY,AGED63YEARS,S/O.SRI.C.T.XAVIER,
SASTHAMPADIKKALHOUSE,OLASSAP.O,KOTTAYAM,
PIN-686014.

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BYADVS.
AJIVDEV
ALANPRIYADARSHIDEV
S.SAJEEVAN

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RESPONDENTS:

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1THESTATEOFKERALA,REPRESENTEDBYCHIEFSECRETARY,
ROOMNO.202,NORTHSANDWICHBLOCK,SECRETARIAT,
THIRUVANANTHAPURAM,PIN-695001.

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2 THE SECRETARY TO GOVERNMENT OF KERALA, HEALTH & FAMILY WELFARE, SECRETARIAT ANNEXE, 2, THIRUVANANTHAPURAM, PIN - 695001.

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3 DIRECTOR OF HEALTH SERVICES, KERALA,NEAR GENERAL HOSPITAL ROAD, JUNCTION, THIRUVANANTHAPURAM, PIN - 695035.

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4 THE ORIENTAL INSURANCE COMPANY LTD,METRO PALACE, XAVIER ARAKKAL RD, OPPOSITE TOWN RAILWAY STATION, ERNAKULAM NORTH, KACHERIPADY, KOCHI, ERNAKULAM, KERALA 682018, REPRESENTED BY ITS REGIONAL MANAGER.

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5 THE PROJECT HEAD, MEDISEP,THE ORIENTAL INSURANCE COMPANY LTD, YWCA BUILDING, M.G. ROAD, THIRUVANANTHAPURAM, PIN - 695001.

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6 ASTER MEDCITY HOSPITAL, KUTTISAHIB ROAD CHERANELLOOR, SOUTH CHITTOOR, KOCHI, KERALA - 682027 REPRESENTED BY ITS CHAIRMAN.

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W.P. (C) No.29689 of 2023

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ADDL R7 THE DISTRICT LEVEL GRIEVANCE REDRESSAL COMMITTEE REPRESENTED BY ITS CONVENOR, THE DISTRICT COLLECTOR. *ADDL R7 IS SUO MOTU IMPLEADED AS ADDITIONAL RESPONDENT AS PER ORDER DATED 16.11.2023 IN WPC NO.29689 OF 2023.

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SRI.GEORGEACHERIAN,SCFORTHEORIENTALINSURANCE
COMPANY

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THISWRITPETITION(CIVIL)HAVINGCOMEUPFORADMISSIONON
16.11.2023,THECOURTONTHESAMEDAYDELIVEREDTHEFOLLOWING:

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W.P. (C) No.29689 of 2023

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JUDGMENT

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The petitioner states that he has retired from the Commercial

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Taxes Department and is a service pensioner. While he was in service, he was enrolled in the MEDISEP scheme. He asserts that he had paid a monthly premium of Rs.500/- and he got included. He states that he was diagnosed with Parkinson’s disease and has been under the treatment for the same at Sree Chithira Thirunal Institute for Medical Science and Technology, Thiruvananthapuram. He was advised to undergo Deep Brain Stimulation Surgery to control the disease. He states that he sought a second opinion from Aster Medicity, Ernakulam and had to undergo surgery. As per the estimate, the amount for surgery would come to about Rs.10,30,000/-. In order to avail of the procedure of a cashless facility, the petitioner contacted the Oriental Insurance Company, the 4th respondent. However, he was informed that the hospital chosen by him has not been empanelled in the network hospitals of MEDISEP and the claim cannot be considered. He states that, being aggrieved he registered a complaint before the grievance cell. Immediately thereafter in terms of the provisions of Ext.P9, which provides for grievance redressal, he preferred

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W.P. (C) No.29689 of 2023

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Ext.P6 complaint before the District Authority. The grievance of the petitioner is that no action has been taken.

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When the matter was taken up for consideration on

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16.10.2023, the petitioner had submitted before this Court that he is not pressing relief No.4.

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When the matter is taken up today, the learned Standing

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Counsel appearing for the 4th respondent submitted that in response to Ext.P4, a mail was issued by the respondents informing the petitioner that Aster Medicity, Kochi is not in the list of hospitals which are empanelled with MEDISEP. The learned counsel further submits that, as per Clause 19 of Ext. P9, a District Level Grievance Redressal Committee has been established as the lowest level authority, with a State Level Grievance Redressal Committee and an Appellate Authority empowered to make final decisions on orders issued by lower authorities. The learned counsel submits that the records disclose that the petitioner has already approached the District Level Grievance Redressal Authority as is borne out from Ext.P6. The learned counsel submits that it would be in the fitness of things to direct the District Level Grievance Redressal Committee, which comprises of the District Collector, Representative Convener, The District Medical Officer, the representative of the Insurer and the Finance Officer of

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W.P. (C) No.29689 of 2023

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the District Collectorate to hear the matter as expeditiously as possible.

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The learned Government Pleader points out that as per

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Ext.P9, the Committee has been ordered to resolve the grievance within thirty days from the date of receiving the application. It is stated that if the petitioner is not satisfied, he can always approach the State Level Committee.

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I have considered the submissions advanced and have gone through the records. The grievance of the petitioner essentially concerns the non-empanelment of the 6th respondent hospital in MEDISEP and also to treat the ailment suffered by the petitioner under the specified category. The records disclose that the petitioner has preferred a complaint before the District Level Authority, which is pending. The time stipulated for grievance redressal is 30 days as per Ext. P9.

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Having considered the submissions, I am of the opinion that necessary directions can be issued to the District Level Grievance Redressal Committee constituted as per Ext.P9 to hear the grievance of the petitioner and take appropriate decision within the time frame mentioned therein.

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The District Level Grievance Redressal Committee represented by its Convenor, the District Collector, is suo motu impleaded

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W.P. (C) No.29689 of 2023

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as the additional respondent. The learned Government Pleader takes notice.

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Resultantly, this petition is disposed of directing the District Level Grievance Redressal Committee before whom the grievance raised by the petitioner is pending to consider the grievance of the petitioner herein and

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to take a decision within thirty days, the time frame mentioned in Ext.P9.

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Sd/- RAJA VIJAYARAGHAVAN V JUDGE

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sru

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W.P. (C) No.29689 of 2023

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APPENDIX OF WP(C) 29689/2023

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PETITIONER’S EXHIBITS

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`Exhibit P1`	`TRUE COPY OF THE HEALTH-CARD ISSUED TO THE` `PETITIONER THROUGH THE MEDISEP PORTAL.`
`Exhibit P2`	`TRUE COPY OF THE SCREEN SHOT OF THE WELCOME` `SCREEN OF THE 'MEDISEP' PORTAL.`
`Exhibit P3`	`TRUE COPY OF THE LETTER OF ESTIMATION OF` `EXPENSES FOR UNDERTAKING DBS SURGERY ISSUED BY` `ASTER MEDCITY DATED: 23.06.2023.`
`Exhibit P4`	`TRUE COPY OF THE E- MAIL DATED: 04.07.2023 SENT` `BY THE PETITIONER TO THE PROJECT HEAD,` `'MEDISEP', ORIENTAL INSURANCE COMPANY ASKING` `THE PROCEDURE TO BE FOLLOWED FOR AVAILING THE` `BENEFIT.`
`Exhibit P5`	`TRUE COPY OF THE REPLY ISSUED BY THE PROJECT` `HEAD, 'MEDISEP' DATED: 25.07.2023.`
`Exhibit P6`	`TRUE COPY THE SCREENSHOT AVAILABLE IN RESPECT` `OF THE COMPLAINT REGISTERED BY THE PETITIONER` `BEFORE THE DISTRICT AUTHORITY USING THE TOKEN` `NUMBER.`
`Exhibit P7`	`TRUE COPY OF THE SCREENSHOT FROM THE 'MEDISEP'` `PORTAL SHOWING THE LIST OF HOSPITALS EMPANELLED` `FOR NEUROSURGERY IN ERNAKULAM DISTRICT.`
`Exhibit P8`	`TRUE COPY OF THE LIST OF ALL THE EMPANELLED` `HOSPITALS IN ERNAKULAM DISTRICT AS PER THE` `'MEDISEP' PORTAL.`
`Exhibit P9`	`TRUE COPY OF THE G.O.(P)NO.70/2022 FIN DATED:` `THIRUVANANTHAPURAM 23.06.2022.`
`Exhibit P10`	`TRUE COPY OF BILL NO. OPCA24/271609 DATED:` `27.07.2023 FOR` ₹`5.870.00.`
`Exhibit10(a)`	`TRUE COPY OF BILL NO. IPCA24/277343 DATED:` `28.07.2023 FOR` ₹`40,193.00`

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W.P. (C) No.29689 of 2023

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ExhibitP10(b) TRUE COPY OF BILL NO. IPCA24/320729 DATED: 14.08.2023 FOR ₹ 10,00,000.00. ExhibitP10(c) TRUE COPY OF BILL NO. OPCA24/320941 FOR ₹ 2,388.85 DATED: 14.08.2023.

Sajan T Sunny v. the State of Kerala

Case brief

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Sajan T Sunny v. the State of Kerala

Case brief

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