Allowed

S. Kannan, v. the Nodel Officer

Madras HC1 Aug 2014WP(MD)/12150/2014

Case brief

AI extract

What is this about?

This petition sought a writ directing the respondent insurance company to issue an No Objection Certificate under the New Health Insurance Scheme, 2012, for reimbursement of medical expenses. The court held that the hospital was approved under a later order and directed the respondent to issue the certificate within three weeks.

What did the court decide?

The writ petition was allowed and the respondent was directed to issue the No Objection Certificate for the petitioner's claim within three weeks.

S. Kannan, Vs the Nodel Officer — Service and Employment | Madras HC (2014)

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BEFORE THE MADURAI BENCH OF MADRAS HIGH COURT

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DATED : 01.08.2014

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CORAM

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THE HONOURABLE MR.JUSTICE T.S.SIVAGNANAM

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W.P.(MD)No.12150 of 2014 and M.P.(MD)No.1 of 2014

S.Kannan

.. Petitioner

The Nodel Officer, United India Insurance Company Ltd., Regional Office, 212, Anna Salai, Chennai -6. .. Respondent

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PRAYER: Petition filed under Article 226 of the Constitution of India praying for the issuance of a Writ of Mandamus directing the Respondent to issue No Objection Certificate to the petitioner under the New Health Insurance Scheme, 2012 within a stipulated time.

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For Petitioner ... Mr.K.Vellaiswamy For Respondent ... Mr.G.Prabhu Rajadurai

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ORDER

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The petitioner seeks for a writ of Mandamus directing the respondent to issue No Objection Certificate to the petitioner under the new Health Insurance Scheme, 2012.

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2.Heard the learned counsel appearing for the petitioner and the learned standing counsel appearing for the respondent.

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3.The petitioner is working as a process server in the District Munsif cum Judicial Magistrate, Vilathikulam, Thoothukudi District. The petitioner enrolled in the Government Health Care Assistance scheme under the New Health Insurance Scheme, 2012 and under the said scheme, the expenditure incurred for treatment by the employee is to be made by the respondent company and the Government entered into an agreement with the respondent for the implementation of the scheme.

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https://hcservices.ecourts.gov.in/hcservices/ 4.The petitioner, while returning to his house on 06.11.2013 in his two wheeler, was knocked down by a car, which was driven in a rash and negligent manner. After knocking down the petitioner,

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the car did not stop and it was driven away in a very high speed. A criminal case has been registered in Crime No.1107 of 2013 on the file of East Police Station, Kovilpatti. The petitioner was admitted for treatment in the Government hospital, Kovilpatti and thereafter for giving better and effective treatment, he was shifted to Kamala Hospital, Kovilpatti. He was inpatient from 06.11.2013 to 12.11.2013 and he has incurred a sum of Rs.37,921/for his medial expenses. The petitioner being a member of the New Health Insurance Scheme, claimed for reimbursement of the said amount, for which purpose, the petitioner is required to produce a No Objection Certificate. The petitioner submitted an application on 03.04.2014. However, the same was not considered and therefore, the petitioner has approached this Court.

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The learned counsel for the petitioner submitted that having received subscription from the petitioner regularly every month, the respondent has no right to deny to give No Objection Certificate.

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The learned counsel for the respondent by placing reliance on G.O.243, Finance (Sal.) Department, dated 29.06.2012, submitted that only three hospitals are approved in Thoothukudi District and the hospital where the petitioner took treatment is not an approved hospital. Further, inviting the attention to clause 14 and 15 of the said Government Order, he submitted that if there is any grievance about any difficulty in availing treatments, nonavailability of facilities, availing of bogus treatment for ineligible individuals, etc, shall be submitted to the Commissioner of Treasuries and Accounts in Chennai and the Joint Director of the Medical and Rural Health Services Department at the District Headquarters. Therefore, it is submitted that the petitioner may submit a complaint, which could be referred to the District level Committee.

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Two issues raised for consideration in this writ petition. Firstly, as to whether the petitioner could be denied the benefit under the New Health Insurance Scheme on the ground that he should take treatment in a particular hospital.

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The objection raised by the respondent company is that the hospital where the petitioner took treatment is not an approved hospital and the hospital does not find place in the approved list mentioned in the Government Order dated 29.06.2012. This objection does not survive, in the light of the recent Government Order in G.O.Rt.No.680, Finance (Salaries) Department, dated 29.07.2013, by which, the Government has included other hospitals in the list of approved hospitals and Kamala Hospital, where the petitioner took treatment also finds place in the list of approved hospitals in https://hcservices.ecourts.gov.in/hcservices/ Serial No.567. The said Government Order having been issued on 29.07.2013 and the petitioner having taken treatment subsequently there too and hence, his claim cannot be rejected. Even assuming

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that the hospital is not an approved hospital that cannot be a ground to deny the claim, since emergency may warrant immediate treatment in a hospital which is located nearer to the place where the accident has occurred. Therefore, this Court is of the view that the list of hospitals mentioned in the Government Order can atbest be only illustrative and cannot be exhaustive and no hard and fast rule can be adopted in this regard and each case has to be considered independently. However, in the instant case, such objection does not survive, since the hospital is an approved hospital.

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The second aspect would be as to whether the petitioner can be denied the benefit of the Insurance scheme when he is an enrolled member of the New Health Insurance Scheme, 2012.

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The eligibility of the petitioner is not disputed and the only dispute was regarding the hospital where the petitioner took treatment. Since it is found that the hospital is an approved hospital, the respondent is bound to issue No Objection Certificate.

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Accordingly, the writ petition is allowed as prayed for and the respondent is directed to issue No Objection Certificate for the petitioner's claim under the New Health Insurance Scheme, 2012, within a period of three weeks from the date of receipt of a copy of this order. Consequently, connected Miscellaneous Petition is closed. No costs.

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Sd/-

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Assistant Registrar(AE) /True Copy/

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Sub-Assistant Registrar

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The Nodel Officer, United India Insurance Company Ltd., Regional Office, 212, Anna Salai, Chennai -6.

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+One cc to Mr.K.Vellaiswamy, Advocate, SR.No.42652 +One cc to Mr.G.Prabhu Rajadurai, Advocate, SR.No.42879 rj2 RL/4 c- 12/8/2014

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

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01.08.2014

S. Kannan, v. the Nodel Officer

Case brief

What is this about?

What did the court decide?

S. Kannan, v. the Nodel Officer

Case brief

What is this about?

What did the court decide?

What the court decided

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Statutes considered

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