1 BEFORE THE MADURAI BENCH OF MADRAS HIGH COURT DATED : 11.11.2011 CORAM THE HONOURABLE MR. JUSTICE K.N. BASHA W.P.(MD)No.8179 of 2011 C.Aruldoss .. Petitioner Vs. 1. The District Collector, District Collector Office, Sivagangai District. 2. The Joint Director, Medical and Rural Welfare Department Office, Sivagangai District. 3. Star Health Insurance Limited, Project Office, 2nd Floor, 8, New Kulatharu, Nungambakkam, Chennai – 600 034. 4. The General Manager, Appollo Hospital, Madurai – 625 020. .. Respondents Prayer : Petition filed under Article 226 of the Constitution of India praying Writ of Mandamus directing the respondents to consider the petitioner's representation dated 22.06.2011 and consequently direct the respondents to pay the balance medical expenses incurred by the petitioner for the treatment. For Petitioner : Mr.V.Muthumani Sivakumar For Respondents-1&2 : Mr.Aayiram K.Selvakumar Government Advocate For Respondent-3 : Mr.G.R.Swaminathan For Respondent-4 : Dispensed with O R D E R The petitioner has come forward with this petition seeking for the relief of direction to the respondents to consider the petitioner's representation dated 22.06.2011 and consequently direct the respondents to pay the balance medical expenses incurred by the petitioner for the treatment. https://hcservices.ecourts.gov.in/hcservices/ 2 2. The case of the petitioner is that he is working as Headmaster at Kuppiayoor Middle School and he had joined Group Medical Insurance Scheme and paying the subscription for every month. He met an accident on 16.04.2011 while he was proceeding from his school to his residence. Thereafter, he was admitted in the fourth respondent hospital and underwent surgery. The petitioner had taken treatment from 16.04.2011 to 27.04.2011 and the fourth respondent had raised a bill for an amount of Rs.1,55,527.54 for the treatment. The petitioner informed the fourth respondent hospital that he had been covered by the Medical Insurance Scheme under the third respondent company. The fourth respondent approached the third respondent and explained about the bill amount, but the third respondent informed them that they could provide only Rs.70,000/- and as a result, the fourth respondent did now allow the petitioner to be discharged from the hospital without paying the entire amount which necessitated the petitioner to sell his wife's jewellery, borrow money from the relatives and to settle the bill to the fourth respondent. Afterwards, the petitioner has been approaching the third respondent for the balance amount, but till date, they have not paid any amount and as such, he has preferred a detailed representation to the third respondent on 22.06.2011. But till date, no action was taken on such representation and as such, he has been constrained to approach this Court with the present petition with the above said prayer. 3. The learned counsel for the petitioner would contend that the petitioner is working as a School Headmaster and he met with an accident and suffered injuries and thereafter, he underwent treatment in the fourth respondent hospital. It is submitted that the hospital/fourth respondent raised bill to the tune of Rs.1,55,527.54 and the petitioner, being covered under the Medical Insurance Claim, informed the hospital to approach the third respondent Insurance Company, but the insurance company paid an amount of Rs.70,000/- and as a result, the petitioner had raised balance amount by selling his wife's jewellery and borrowing money from the relatives. It is contended that after the payment and discharge, the petitioner approached the third respondent on several occasions and also preferred a written representation dated 22.06.2011, but till date no action was taken. 4. Per contra, learned Standing Counsel for the third respondent would submit that the third respondent insurance company has already paid an amount of Rs.70,000/- as per the entitlement of the petitioner. It is pointed out by the learned counsel that as per the Division Bench decision of this Court in Star Health and Allied Insurance Co. Ltd., V. A.Chokkar and another reported in 2010-2-L.W. 90, the petitioner has to approach only the Government for reimbursement of the balance amount. 5. Heard the learned Government Advocate on the submissions made by the learned counsel for the petitioner and the learned counsel for the third respondent. The learned Government Advocate would submit that action was taken on the representation made by the petitioner. It is further submitted that a communication dated 12.07.2011 was sent to the petitioner by the Treasury Officer, Sivagangai District, for mutual discussion, but the petitioner has not responded to such communication. https://hcservices.ecourts.gov.in/hcservices/ 3 6. However, learned counsel for the petitioner would submit that due to his illness, he was not able to contact the Treasury Officer as per the communication dated 12.07.2011. 7. This Court carefully considered the rival contentions put forward by either side and perused the entire materials available on record. 8. The fact remains that the petitioner is working as a Headmaster in a school and he met with an accident and underwent treatment at the fourth respondent hospital. The hospital raised a bill for an amount of Rs.1,55,527.54. It is seen that the petitioner was covered under the Medical Insurance Scheme and paid the subscription every month and accordingly, the third respondent insurance company accepted the liability only to the tune of Rs.70,000/- and the said amount was already paid. The learned Standing Counsel for the third respondent also brought to the notice of this Court about the Division Bench decision of this Court in Star Health and Allied Insurance Co. Ltd., V. A.Chokkar and another reported in 2010-2-L.W. 90. In the said decision, the Division Bench has held as hereunder : "27. Now coming to the individual cases, in all the case, whatever may be the category, the petitioners/claimants have paid the amount. The scheme is a 'cashless' one and, therefore, it is only the Government which have to make the payment under the Rules. The Redressal Committee is empowered to decide the following circumstances, namely, any difficult in availing treatment, non-availability of facilities, bogus availment of treatment for ineligible individuals, etc. It is really not clear what other complaints would be covered under the umbrella "etc". But, however, since the Paragraph relating to 'Redressal of Grievances' starts with the sentence "The Hospitals shall extend treatment to the beneficiaries under the Scheme on a cashless basis", it is evident that the Committee cannot direct payment of cash." In the Division Bench decision , it is clearly held that it is for the claimant to approach the Government as incorporated in the earlier paragraph. 9. As far as the case on hand is concerned, it is seen that the petitioner has already approached the Government by preferring a representation dated 22.06.2011 to the District Collector, Sivagangai District, The Joint Director of Rural Welfare Department, and the Treasury Officer, Sivagangai District. But in respect of the said representation, no action was taken till date. The District Collector/the first respondent herein could have very well forwarded, the representation of the petitioner to the Special Secretary, Finance (Salaries) Department, Secretariat, Chennai, for considering the said representation. But unfortunately, the District Collector has not forwarded the representation received from the petitioner or informed the petitioner that he has to approach the Government. 10. Under the said circumstances, the petitioner is directed to send a fresh copy of the representation dated 22.06.2011 to the Special Secretary, Finance (Salaries) Department, Government of Tamil Nadu, Chennai, within a period of 10 days from the date of receipt of a copy of this order and on receipt of such representation, the Special Secretary, Finance (Salaries) https://hcservices.ecourts.gov.in/hcservices/ 4 Department, Government of Tamil Nadu, Chennai, shall consider the representation of the petitioner in the light of the Division Bench decision of this Court in Star Health and Allied Insurance Co. Ltd., V. A.Chokkar and another reported in 2010-2-L.W. 90 and sanction the amount towards Medical reimbursement to the petitioner as per his entitlement within a period of eight weeks from the date of receipt of the representation. With the above direction, this writ petition is disposed of. SD/- Assistant Registrar(AE) /True copy/ Sub Assistant Registrar(CS) To 1. The District Collector, District Collector Office, Sivagangai District. 2. The Joint Director, Medical and Rural Welfare Department Office, Sivagangai District. 3.The Special Secretary, Finance (Salaries) Department, Govt. of Tamil Nadu, Chennai. +1 CC to the Special Government Pleader, Sr.No.39493 gg W.P.(MD)No.8179 of 2011 11.11.2011 TR : 30.11.2011 : 4P/5C https://hcservices.ecourts.gov.in/hcservices/