Dismissed

Y.Samuvel Raj, v. the Secretary to Government

Madras HC1 Mar 2013WP(MD)/3238/2013

Case brief

AI extract

What is this about?

In a writ petition, the Court dismissed the petitioner's claim for medical reimbursement of his son's hospital expenses. The Court held that despite the petitioner's payment, he must approach the Redressal Committee as neither the original nor the new insurance agency was liable to pay directly.

What did the court decide?

Petitioner directed to approach Redressal Committee for reimbursement; connected MP closed; no costs.

Y.Samuvel Raj, Vs the Secretary to Government — Pension and Retirement Benefits | Madras HC (2013)

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BEFORE THE MADURAI BENCH OF MADRAS HIGH COURT

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DATED : 01.03.2013

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CORAM

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THE HONOURABLE MR.JUSTICE R.S.RAMANATHAN

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W.P.(MD)No.3238 of 2013

and

M.P.(MD)No.1 of 2013

Y.Samuvel Raj

.. Petitioner

vs.

1.The Secretary to Government,

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Finance (Salaries) Department, Government of Tamil Nadu

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Fort St.George,

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Chennai 9.

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2.The Senior General Manager,

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Star Health & Allied Insurance Co. Ltd., (Tamil Nadu Govt. Employees New

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Health Insurance Scheme)

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Project Office, 2^nd Floor,

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No.2A, Ganga Nagar Road,

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Opp. BSNL Office,

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Kodambakkam, Chennai 600 024.

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3.The District Collector,

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Kanyakumar District.

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4.The General Manager,

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Tamil Nadu State Transport Corporation,

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Rani Thottam,

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Nagercoil, Kanyakumari District.

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.. Respondents

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PRAYER: Petition filed under Article 226 of the Constitution of India, praying for the issuance of a Writ of Certiorarified Mandamus calling for the records relating to the impugned order of the fourth respondent in Memorandum No.1196/Tho.Na/ThaAPoKa(Thili)/2012 dated 22.01.2013 and quash the same consequently direct the respondents herein to jointly disburse the sum of Rs.1,71,880/- towards medical reimbursement borne out by records together with nominal rate of interest at 7.5% p.a., thereon from the date of application of the petitioner.

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For Petitioner : Mr.R.Russel Raj

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https://hcservices.ecourts.gov.in/hcservices/

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For R1 & R2 : Mr.C.Selvaraj Special Government Pleader For R4 : Mr.K.Sathiyasingh

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O R D E R

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The petitioner is employed as a driver in the fourth respondent Corporation, which is owned by the Government. The Government of Tamil Nadu entered into an agreement with the second respondent for providing Health Insurance to the servants and G.O.Ms.No.430, dated 10.09.2007 was issued by the Government appointing the second respondent as the agent of the Government to draw the Health fund from the salaries of the Government employees and provide with health Insurance and the petitioner is also covered under the Health Insurance Scheme.

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On 16.08.2012, the petitioner's son S.Jacob Sweetlin Raj, was admitted in Ananthapuri Hospital at Trivandrum and he underwent surgery and thereafter, he was discharged on 31.08.2012. The petitioner incurred a sum of Rs.1,71,880/- towards medical expenses and approached the fifth respondent for reimbursement and the fifth respondent passed the impugned order dated 22.01.2013 stating that the Health Insurance Scheme 2012, is undertaken by the United India Insurance Company Limited and Ananthapuri Hospital, where the petitioner's son took treatment was not a recognized hospital and therefore, the request of the petitioner for reimbursement cannot be entertained. This order is challenged in this writ petition.

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It is submitted by the learned counsel for the petitioner that the petitioner was not aware that the Government has changed the agency from the second respondent to the United India Insurance Company Limited and admittedly, Ananthapuri Hospital was one of the network hospital covered by the second respondent and the petitioner's son took treatment in that hospital and therefore, the petitioner is entitled to reimbursement of the medical claim from the second respondent and the rejection of the claim on the ground that the United India Insurance Company Limited is the agency to pay the health insurance amount and Ananthapuri Hospital is not recognized by the said Insurance Company, cannot be accepted, as the petitioner was not aware that the agency has been changed from the second respondent to United India Insurance Company Limited. He, however, submitted that being a Insured person, he is entitled to get reimbursement as per the policy and therefore, the respondents are liable to reimburse the amount and the order is liable to be set aside.

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Mr.K.Sathiyasingh took notice for the fourth respondent and submitted that as per the Judgement in 2010 (2) L.W. 90 (STAR HEALTH AND ALLIED INSURANCE CO. LTD. v. A.CHOKKAR & ANOTHER) , the petitioner is not entitled to reimburse, even assuming that Ananthapuri Hospital is one of the network hospitals covered by the second respondent.

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I have gone through the Judgement reported in 2010 (2) L.W. 90 (stated supra), wherein the learned Division Bench held that if the claimants have made payments whether for a procedure not covered or whether at a non-network hospital or they have paid when they have https://hcservices.ecourts.gov.in/hcservices/ been treated for a covered procedure in a network hospital, they have to approach the Redressel Committee for reimbursement.

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Admittedly, the petitioner has made payment for the medical expenses incurred by him and irrespective of the fact that whether Ananthapurai Hospital is a covered network hospital or not, having regard to the fact that payment was already made by the petitioner, neither the second respondent nor the United India Insurance Company, are liable to make the payment and the only remedy available to the petitioner is to approach the Redressel Committee for payment.

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Hence, the writ petition is disposed of by directing the petitioner to approach the Redressel Committee headed by the third respondent for medical reimbursement. Consequently, connected Miscellaneous Petition is closed. No costs.

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Sd/-

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Assistant Registrar (CO)

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/True Copy/

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Sub Assistant Registrar

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1.The Secretary to Government, Finance (Salaries) Department, Government of Tamil Nadu

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Fort St.George, Chennai 9.

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2.The Senior General Manager,

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Star Health & Allied Insurance Co. Ltd.,

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(Tamil Nadu Govt. Employees New

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Health Insurance Scheme)

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Project Office, 2^nd Floor, No.2A, Ganga Nagar Road,

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Opp. BSNL Office, Kodambakkam, Chennai 600 024.

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3.The District Collector, Kanyakumar District.

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4.The General Manager, Tamil Nadu State Transport Corporation, Rani Thottam, Nagercoil, Kanyakumari District.

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+1. CC to Mr.R.Russel Raj, Advocate, SR.No.11714

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+1. CC to Mr.K.Sathiya Singh, Advocate, SR.No.12153

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W.P.(MD)No.3238 of 2013 and M.P.(MD)No.1 of 2013 01.03.2013

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rj2 https://hcservices.ecourts.gov.in/hcservices/ NSV/15.3.13/3P/7C

Y.Samuvel Raj, v. the Secretary to Government

Case brief

What is this about?

What did the court decide?

Y.Samuvel Raj, v. the Secretary to Government

Case brief

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