P. Victor v. United India Insurance Co. Ltd, Chennai
2015-02-12
K.RAVICHANDRA BAABU
body2015
DigiLaw.ai
Judgment 1. This Writ Petition has been filed challenging the order of the first respondent dated 21.03.2014 and for a further direction to the first respondent to pay a sum of Rs.2,76,148/- towards the medical expenses incurred by the petitioner for the treatment given to his wife. 2. Through the impugned order, the claim of the petitioner was rejected only on the reason that the treatment was taken in a non-network hospital/non-empanelled hospital. 3. Though notice of motion was ordered in this matter on 30.04.2014, the respondents have not filed any counter affidavit sofar nor there is an appearance for the first respondent. 4. The learned counsel appearing for the petitioner submits that the issue involved in this case is squarely covered by a decision of this Court made in W.P.(MD).No.14585 of 2013 dated 21.01.2014 in favour of the petitioner. 5. It is seen that the petitioner is working as a Junior Engineer at Highways Department. It is further stated that his wife was admitted in BGM Hospital, Madurai and took treatment from 09.04.2013 to 30.05.2013 due to flame burn. It is further stated that the petitioner incurred a sum of Rs.2,76,148/- towards the medical expenses for treating his wife. When such expenses meted out by the petitioner was sought to be reimbursed, the present impugned order came to be passed by stating that the said BGM Hospital, Madurai is a non-network hospital / non empanelled hospital. The issue as to whether medical reimbursement can be denied on the sole reason that the treatment was taken in a non-network hospital/non-empanelled hospital was already considered and decided by this Court against the respondents holding that such cannot be a ground to deny medical reimbursement to the Government servant. One such recent decision was made in W.P.(MD).No.14585 of 2013 dated 22.01.2014, wherein, the learned Single Judge at paragraph Nos.3 to 6 has held as follows:- “3.As rightly submitted by the learned counsel appearing for the petitioner, the issue involved is no longer res integra. Considering the very same issue, this Court in the order in W.P.No.8449 of 2007 (A.Nagoor Pitchai v. State of Tamil Nadu rep. by the Director, Land and Survey Department, Ezhilagam, Chepauk, Chennai -5 and others) dated 15.09.2013, was pleased to held as follows: “8.
Considering the very same issue, this Court in the order in W.P.No.8449 of 2007 (A.Nagoor Pitchai v. State of Tamil Nadu rep. by the Director, Land and Survey Department, Ezhilagam, Chepauk, Chennai -5 and others) dated 15.09.2013, was pleased to held as follows: “8. In regard to the reasons as to the non inclusion of the Hospital in Government Order for denial, this Court cannot brush aside the advancement in modern medical treatment. Speciality Hospitals are established for treatment for specified ailments and services of Doctors specialized in a discipline are availed by patients only to ensure proper, required and safe treatment. Can it be said that taking treatment in Speciality Hospital by itself would deprive the beneficial order of the Government, solely on the ground that the said Hospital is not included in the Government Order. It cannot be so, as the Government Order should be read keeping the purpose for which the same was issued. The right to medical claim cannot be denied merely because the name of the hospital is not included in the Government Order. The real test must be the factum of treatment. Before any medical claim is honoured, the authorities are bound to ensure as to whether the claimant had actually taken treatment and the factum of treatment is supported by records duly certified by Doctors/Hospitals concerned. Once, it is established, the claim cannot be denied on technical grounds as found in the impugned order. Having regard to the above lacunae in the earlier Government Order and issuance of subsequent Government Order including not only the treatment but also the hospital, I am of the view that the petitioner is entitled to claim reimbursement. 4. Another learned single Judge of this Court in a decision made in W.P.No.2714 of 2007 (T), (O.A.No.5757 of 2001) dated 4.11.2011 has observed at paragraphs 5 and 6 as follows: “5. When a person is struggling for life and when his family members want to save his life, no body would search for a recognised hospital for future medical reimbursement. It is not the case of the respondents that no surgery was performed. Having admitted that heart surgery was performed, the respondents are not correct in refusing to reimburse the medical expenses. 6. The very purpose of the health scheme is to help the ailing employees particularly when they are faced with major problems such as Heart Surgery, etc.
It is not the case of the respondents that no surgery was performed. Having admitted that heart surgery was performed, the respondents are not correct in refusing to reimburse the medical expenses. 6. The very purpose of the health scheme is to help the ailing employees particularly when they are faced with major problems such as Heart Surgery, etc. In a similar circumstances, this Court in K.Mani Vs. Secretary to Government, Health and Family Welfare Department, Chennai and Others [ 2007(3) MLJ 34 ] and Mr.K.Balaswami Vs. Director of Pension, Chennai and Another [ 2007(3) MLJ 385 ], held that medical reimbursement should not be denied on the ground that the petitioner failed to undergo heart surgery in the hospital recognised by Government of Tamilnadu”. 5. I find that the above two decisions rendered by the learned single Judges of this Court squarely apply to the facts and circumstances of the present case and consequently the petitioner is entitled to succeed based on those two decisions rendered by this Court. 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 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 Judges 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.” 6. In the light of the above judgment and considering the fact that the issue involved in this case is squarely covered by such decision, I am of the view that the petitioner has to succeed in this Writ Petition.
In the light of the above judgment and considering the fact that the issue involved in this case is squarely covered by such decision, I am of the view that the petitioner has to succeed in this Writ Petition. Accordingly, this Writ Petition stands allowed and the impugned order stands set aside and the respondents are directed to reimburse the eligible medical expenses to the petitioner, within a period of eight weeks from the date of receipt of a copy of this order. No costs. Consequently, the connected miscellaneous petition is closed.