Disposed¶60

M.Kannan v. the State of Tamilnadu

Madras HC9 Mar 2026WP/5826/2024

Case brief

AI extract

What is this about?

CMCHIS reimbursement; Writ of Mandamus; Article 226; Rs.6,05,000/- heart surgery; CABG; imported Honcock valve; Madras Medical Mission; Tamil Nadu Health Systems Project (TNHSP); Vidal Health Insurance TPA Pvt Ltd; RTI reply dated 20.12.2023; eligibility 2022 to 2027; representation dated 25.09.2023 not considered; direction to second respondent to consider claim within four weeks; disposed of, no costs; M. Dhandapani J.; W.P.No.5826 of 2024; decision dated 09.03.2026.

What did the court decide?

Direction to the second respondent to consider the petitioner's reimbursement claim as per the RTI reply dated 20.12.2023 and pass appropriate orders within four weeks; writ petition disposed of with the above directions, no costs. ¶60

M.Kannan Vs the State of Tamilnadu — Writ and Judicial Review | Madras HC (2026)

What the court decided

AI extract

Outcome

¶60

Issue for consideration

Whether the petitioner is entitled to reimbursement of Rs.6,05,000/- spent for his father's heart surgery (involving an imported 'Honcock' valve) under the Chief Minister Comprehensive Health Insurance Scheme. +1 more

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Court's answer

The petitioner's representation dated 25.09.2023 seeking reimbursement was not considered by the respondents, and although the claim was refused, no proper order was passed.

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Ratio / Principle

The Court directed the second respondent (Project Director, Tamil Nadu Health Systems Project) to consider the petitioner's claim as per the RTI reply dated 20.12.2023 and to pass appropriate orders within four weeks from receipt of a copy of the order.

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Detailed headnote1 paragraphs

MADRAS HIGH COURT (M. Dhandapani, J.) | W.P.No.5826 of 2024 | 09.03.2026 | Writ of Mandamus under Article 226 sought by M. Kannan, a practising advocate, for reimbursement of Rs.6,05,000/- spent on his father V.M.Muthu's heart surgery (CABG with an imported 'Honcock' valve) at Madras Medical Mission, claimed under the Chief Minister's Comprehensive Health Insurance Scheme. Respondents - State of Tamil Nadu, Project Director TNHSP, CMCHIS, Joint Director of Health Services (Thiruvallur) and Vidal Health Insurance TPA Pvt. Ltd. - contended that the imported valve is permissible only in a Government Hospital, that the petitioner discontinued the insurance claim route and opted for private treatment by letter dated 25.09.2023 paying on his own volition, and that a claim initially processed through the third-party administrator was cancelled at his instigation. The petitioner relied on an RTI reply dated 20.12.2023 recording that imported Stent Honcock Valve is eligible for coverage under the scheme from 2022 to 2027. Finding that his representation dated 25.09.2023 was never considered and that the refusal carried no proper order, the Court directed the second respondent to consider the claim as per that RTI reply and pass appropriate orders within four weeks; writ petition disposed of, no costs.

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W.P.No.5826 of 2024

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IN THE HIGH COURT OF JUDICATURE AT MADRAS

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DATED : 09.03.2026

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CORAM

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THE HONOURABLE MR.JUSTICE M.DHANDAPANI

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W.P.No.5826 of 2024

M.Kannan

... Petitioner

Vs.

1 THE STATE OF TAMIL NADU

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REP. BY IT’S THE PRINCIPAL SECRETARY TO GOVERNMENT, HEALTH, MEDICAL EDUCATION AND FAMILY WELFARE, SECRETARIAT, FORT ST. GEORGE,

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CHENNAI – 600 009.

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2 THE PROJECT DIRECTOR,

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TAMIL NADU HEALTH SYSTEMS PROJECT (TNHSP), 3RD FLOOR, DMS ANNEX NEW BUILDING,

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259, ANNA SALAI,

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TEYNAMPET,

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CHENNAI – 600 006.

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3 THE CHIEF MINISTER’S COMPREHENSIVE HEALTH INSURANCE SCHEME,

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REP. BY ITS PROJECT OFFICER,

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NO.226, OM SAKTHI TOWERS,

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KILPAUK GARDEN ROAD,

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KILPAUK,

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CHENNAI – 600 010.

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4 THE JOINT DIRECTOR OF HEALTH SERVICES,

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HEALTH DEPARTMENT,

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THIRUVALLUR DISTRICT,

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THIRUVALLUR – 602 001.

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1/8

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https://www.mhc.tn.gov.in/judis

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W.P.No.5826 of 2024

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5 M/S. VIDAL HEALTH INSURANCE TPA PVT. LTD., REP. BY ITS AUTHORIZED OFFICER, O/O. THE CHIEF MINISTER’S COMPREHENSIVE HEALTH INSURANCE SCHEME, NO.226, OM SAKTHI Plaza, KILPAUK GARDEN ROAD, KILPAUK, CHENNAI – 600 010. ... Respondents

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Prayer:

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Petition filed under Article 226 of the Constitution of India to issue a Writ of Mandamus directing the respondents to reimburse the entire medical expenses for a sum of Rs.6,05,000/- spent by the petitioner for his father’s heart surgery under the Hon’ble Chief Minister Comprehensive Health Insurance Scheme forthwith.

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For Petitioner : Mr.M.R.Jothimanian For Respondents : Mr.K.Tippu Sultan for R1, R2 and R4 Government Advocate Mr.S.Arun Kumar for R3, R5

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O R D E R

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The petitioner has filed this writ petition seeking issuance of Writ of Mandamus directing the respondents to reimburse the entire medical expenses for a sum of Rs.6,05,000/- spent by the petitioner for his father’s heart surgery under the Chief Minister Comprehensive

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Health Insurance Scheme forthwith.

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2.The learned counsel appearing for the petitioner submitted

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2/8

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https://www.mhc.tn.gov.in/judis

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W.P.No.5826 of 2024

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that the petitioner is a practicing Advocate and his family members are members under the Chief Minister’s Comprehensive Health Insurance Scheme. The petitioner’s father V.M.Muthu experienced chest pain on 12.09.2023 and was immediately taken to Madras Medical Mission in Mogappair, Chennai and on 13.09.2023, the petitioner’s family applied for Chief Minister’s Comprehensive Health Insurance Scheme and after a brief hospitalization, the petitioner’s father was discharged from the Hospital on 14.09.2023. On 16.09.2023, the petitioner’s father was again admitted in the same Hospital and the medical team determined that the petitioner’s father is in urgent need of Coronary Artery Bypass Grafting (CABG) surgery along with placement of TTK Chitra Valve. Initially the petitioner’s family received approval from the Insurance Company, however, the Doctors informed that the petitioner’s father required imported Honcock valve and the Insurance team stated that imported valves are not eligible for coverage under Chief Minister’s Comprehensive Health Insurance Scheme.

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3.The learned counsel appearing for the petitioner further

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submitted that the petitioner’s family belongs to an economically underprivileged background and the petitioner sought financial assistance from his colleagues and the surgery was successfully

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3/8

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https://www.mhc.tn.gov.in/judis

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W.P.No.5826 of 2024

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completed. Thereafter the petitioner made representation dated 25.09.2023 to the respondents seeking reimbursement of the medical expenses and the fourth respondent made reply on 17.11.2023 and aggrieved by the same, the petitioner filed appeal on 17.10.2023, however, the fourth respondent gave the very same reply. The learned counsel further submitted that the petitioner made application under Right to Information Act with regard to the Chief Minister’s Comprehensive Health Insurance Scheme and came to know that imported Stent Honcock Valve is eligible for coverage under the Chief Minister’s Comprehensive Health Insurance Scheme from 2022 to 2027. Though the petitioner is eligible to claim reimbursement of the medical expenses, the same is not disbursed by the respondents. Hence, this Court may, without going into the merits of the case, issue direction to the second respondent to consider the claim of the petitioner as per their RTI reply dated 20.12.2023 and to pass appropriate orders.

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4.The learned Government Advocate appearing for the respondents 1, 2 and 4 submitted that as per the Chief Minister’s Comprehensive Health Insurance Scheme, Honcock Valve is permissible only in the Government Hospital and the same is not 4/8

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https://www.mhc.tn.gov.in/judis

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W.P.No.5826 of 2024

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permissible in the Private Hospital and further submitted that when a person is inclined to get treatment in a private Hospital, there is no need for the Insurance Company for payment of any amount to the private Hospital. He further submitted that on 13.09.2023, the petitioner’s family applied for Chief Minister’s Comprehensive Health Insurance Scheme and the same was under active consideration of the respondents and subsequently, the petitioner dis-continued the earlier mode of claim and he himself opted for treatment in private Hospital by giving letter dated 25.09.2023 to Madras Medical Mission for early operation and further submitted that the petitioner paid the amount on his own volition in the private Hospital and hence, the petitioner cannot claim reimbursement of the medical expenses.

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5.The learned counsel appearing for the respondents 3 and 5 submitted that there is contract between the State Government and the Insurance Company and the contract provide for payment of the insurance claim claimed through third party Administrator. In the present case, it was initially presented for claim through third party Administrator and that was processed and subsequently, the procedure was cancelled at the instigation of the petitioner and further submitted that the petitioner on his own volition spent amount to the

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https://www.mhc.tn.gov.in/judis

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W.P.No.5826 of 2024

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private Hospital and the Hospital performed surgery and hence the petitioner is not entitled for reimbursement of the amount.

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6.Heard the arguments advanced on either side and perused the materials available on record.

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7.Perusal of records disclose that the petitioner made representation dated 25.09.2023 to the respondents seeking reimbursement of the medical expenses incurred for his father’s surgery, however, the same was not considered by the respondents. Though the respondents refused the same, there is no proper order. Hence, this Court directs the second respondent to consider the claim of the petitioner as per their RTI reply dated 20.12.2023 and to pass appropriate orders, within a period of four weeks from the date of receipt of a copy of this order.

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8.The writ petition is disposed of with the above directions. No costs.

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09.03.2026

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pri Index: Yes/ No Speaking Order: Yes/ No NCC: Yes/ No

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6/8

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https://www.mhc.tn.gov.in/judis

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W.P.No.5826 of 2024

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1 THE PRINCIPAL SECRETARY TO GOVERNMENT,

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HEALTH, MEDICAL EDUCATION AND FAMILY WELFARE,

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SECRETARIAT, FORT ST. GEORGE, CHENNAI – 600 009.

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2 THE PROJECT DIRECTOR, TAMIL NADU HEALTH SYSTEMS PROJECT (TNHSP), 3RD FLOOR, DMS ANNEX NEW BUILDING, 259, ANNA SALAI, TEYNAMPET,

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CHENNAI – 600 006.

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3 THE CHIEF MINISTER’S COMPREHENSIVE HEALTH INSURANCE SCHEME,

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REP. BY ITS PROJECT OFFICER, NO.226, OM SAKTHI TOWERS, KILPAUK GARDEN ROAD, KILPAUK,

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CHENNAI – 600 010.

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4 THE JOINT DIRECTOR OF HEALTH SERVICES, HEALTH DEPARTMENT, THIRUVALLUR DISTRICT, THIRUVALLUR – 602 001.

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5 M/S. VIDAL HEALTH INSURANCE TPA PVT. LTD., REP. BY ITS AUTHORIZED OFFICER, O/O. THE CHIEF MINISTER’S COMPREHENSIVE HEALTH INSURANCE SCHEME,

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NO.226, OM SAKTHI Plaza, KILPAUK GARDEN ROAD, KILPAUK,

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CHENNAI – 600 010.

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7/8

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https://www.mhc.tn.gov.in/judis

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W.P.No.5826 of 2024

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M.DHANDAPANI,J. pri

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W.P.No.5826 of 2024

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09.03.2026

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8/8

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https://www.mhc.tn.gov.in/judis

Procedural history

How this case reached the court

AI extract

Order under challenge
Reply dated 17.11.2023 issued by the fourth respondent to the petitioner's representation seeking reimbursement; the very same reply was repeated after the petitioner's appeal, and no proper order was passed despite the refusal of the claim.¶48
Fourth respondent - Joint Director of Health Services, Health Department, Thiruvallur District · 17.11.2023
Prior proceeding
Petitioner's father V.M.Muthu experienced chest pain on 12.09.2023 and was taken to Madras Medical Mission, Mogappair, Chennai; the family applied under the Chief Minister's Comprehensive Health Insurance Scheme on 13.09.2023; after brief hospitalization he was discharged on 14.09.2023 and readmitted on 16.09.2023, when the medical team determined he urgently needed Coronary Artery Bypass Grafting (CABG) surgery along with placement of a TTK Chitra Valve.¶42
Prior proceeding
Initially the family received approval from the Insurance Company, but the Doctors informed that the petitioner's father required an imported 'Honcock' valve, and the Insurance team stated that imported valves are not eligible for coverage under the Chief Minister's Comprehensive Health Insurance Scheme.¶42
Prior proceeding
Petitioner made a representation dated 25.09.2023 to the respondents seeking reimbursement of the medical expenses; the fourth respondent replied on 17.11.2023; aggrieved, the petitioner filed an appeal on 17.10.2023 (date as printed) and received the very same reply.¶48
Prior proceeding
Petitioner applied under the Right to Information Act regarding the scheme and learnt that imported Stent Honcock Valve is eligible for coverage under the Chief Minister's Comprehensive Health Insurance Scheme from 2022 to 2027; counsel accordingly sought a direction to the second respondent to consider the claim as per the RTI reply dated 20.12.2023.¶48
Prior proceeding
Submission of counsel for respondents 1, 2 and 4: as per the Chief Minister's Comprehensive Health Insurance Scheme, the Honcock Valve is permissible only in a Government Hospital and not in a private hospital; hence no amount is payable when treatment is obtained privately.¶49
Prior proceeding
Submission of counsel for respondents 1, 2 and 4: the scheme application of 13.09.2023 was under active consideration, but the petitioner discontinued the earlier mode of claim, opted for treatment in a private hospital by letter dated 25.09.2023 to Madras Medical Mission for early operation, and paid the amount on his own volition; reimbursement is therefore not claimable.¶52
Prior proceeding
Submission of counsel for respondents 3 and 5: the claim was initially presented through the third-party administrator and was processed, but the procedure was cancelled at the petitioner's instigation; having voluntarily spent the amount at the private hospital where the surgery was performed, the petitioner is not entitled to reimbursement.¶53

M.Kannan v. the State of Tamilnadu

Case brief

What is this about?

What did the court decide?

M.Kannan v. the State of Tamilnadu

Case brief

What is this about?

What did the court decide?

Why is it important?

What the court decided

Issues for consideration

Statutes considered

Procedural history

Parties & counsel

Coram

Case details

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