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Judgment
N. Paul Vasanthakumar, J.—In this writ petition, petitioner seeks to quash the proceedings of the third respondent dated 3.3.2006 and to
direct the fourth respondent to give effect to the sanction order dated 7.12.2005 passed by the third respondent.
The brief facts necessary for disposal of the writ petition as stated in the affidavit in support of the writ petition are as follows.
(a) Petitioner entered into service on 5.4.1967 and he was the regular subscriber to the Tamil Nadu Government Employees Health Fund Scheme
from its inception, i.e., from 9.1.1992. He, after serving as Assistant Agricultural Officer, Palayamkottai, in the Government of Tamil Nadu, retired
from service on 30.11.2001.
(b) Petitioner''s son M. Anto Arokiya Prince was admitted in the Tirunelveli Medical College Hospital on 26.12.1997 and he was treated for
kidney problem. The Doctors found that both his kidneys were failed and advised the petitioner to admit his son in the Tirunelveli Kidney Care
Centre. Petitioner''s son was given treatment in that Centre from 31.12.1997 to 8.1.1998. Thereafter, as per the advice of the Doctors,
petitioner''s son was admitted in the CMC Hospital, Vellore on 14.1.1998 where he was given continuous treatment. On 2.3.1998, petitioner''s
son was operated for kidney transplantation and at that time he developed more complications and dialysis took place for 50 times. In spite of the
continuous treatment, petitioner''s son died on 18.5.1998.
(c) Petitioner states that he spent Rs. 1,73,572/- for treatment of his son and as per G.O.Ms. No. 236 Finance (Salaries) Department, dated
30.3.1995, he is entitled to get reimbursement of Rs. 1,00,000/- from the Tamil Nadu Government Employees Health Fund Scheme since he was
a regular subscriber to the Scheme. Petitioner applied for medical reimbursement under the said Scheme through the department and the same was
not sanctioned even though he produced the medical certificates to prove his claim. The second respondent, who is the competent authority to
sanction the amount, following the orders of the first respondent dated 7.2.2002, sanctioned the amount in his proceedings dated 5.12.2003 and
directed the fourth respondent to issue demand draft for a sum of Rs. 1,00,000/-.
(d) The 4th respondent returned the bill by his proceedings dated 9.1.2004 stating that the date of receipt of the application to be noted, claim was
not made within 60 days and since the patient died before operation, claim could not be admitted. The second respondent by his proceedings
dated 24.1.2005, requested the first respondent to get Government sanction to allow the claim of the petitioner. First respondent, in his
proceedings dated 25.2.2005 directed the second respondent to send all the documents including discharge summary of the petitioner. Again, first
respondent by proceeding dated 17.5.2005 directed the second respondent to send reply if any made by him to the 4th respondent.
(e) The Second respondent again sanctioned the amount of Rs. 1,00,000/- in his proceedings dated 7.12.2005. However, the same was again
returned by the 4th respondent on 20.1.2006 stating that the claim could not be admitted. The third respondent in his proceedings dated 3.3.2006
referring the proceeding of the second respondent dated 21.2.2006 stated that the calim of the petitioner was rejected on the ground that kidney
operation was not performed. Petitioner submits that on 2.3.1998 petitioner''s son''s one of the kidney was operated and removed and sent for
analysis to the Laboratoryat Taramani, Chennai and 50 times dialysis was done. Petitioner made claim application on 9.2.1998 and after a period
of eight long years his claim is rejected. Hence the petitioner filed the present writ petition with the above prayer.
Third respondent has filed the counter affidavit and admitted that the petitioner was regularly contributing to the Tamil Nadu Government
Employees Health Fund Scheme from 9.1.1992. The averments of the petitioner that his son was originally admitted at the Tirunelveli Medical
College Hospital and thereafter admitted in the Kidney Care Centre, Tirunelveli and then shifted to the CMC Hospital, Vellore are all admitted.
However, in the counter affidavit, it is stated that before renal transplantation, nephectomy excision of his right kidney was done and sent to
Taramani Laboratory for test on 2.3.1998 and while petitioner''s son was under continuous treatment, he died on 18.5.1998. It is also admitted
that the expenditure incurred for treatment is Rs. 1,58,987/- and the petitioner is entitled to get reimbursement of expenses incurred on specialised
surgery/treatment of his son to the maximum of Rs. 1,00,000/- as per G.O.Ms. No. 236, dated 30.3.1995. It is further stated in the counter
affidavit that the competent authority/the second respondent accorded sanction for a sum of Rs. 1,00,000/- as per the said scheme, but the 4th
respondent finally rejected the claim on the ground that the patient died before operation. It is also admitted in the counter that one of the kidney of
the petitioner''s son was operated and removed and sent for analysis to the Laboratory at Taramani, Chennai and petitioner''s son underwent
dialysis several times. The reason stated by the third respondent is that renal transplantation has not been done and hence the claim is inadmissible.
It is also stated in the counter affidavit that the removal of one of the kidney of the petitioner''s son and subsequent sending of the same for analysis
to Lab at Taramani has not been taken into consideration as special surgery.
I have considered the rival submissions of the learned Counsel appearing for the petitioner as well as the learned Special Government Pleader.
The point in issue is whether the petitioner is entitled to get the sum of Rs. 1,00,000/- as medical reimbursement, spent towards the treatment of
the petitioner''s deceased son.
From the the counter affidavit it is clear that the petitioner was regularly contributing to the Tamil Nadu Government Employees Health Fund
Scheme from its inception from 9.1.1992. The admission of petitioner''s son in Tirunelveli Medical College Hospital on 26.12.1997; his admission
in Kidney Care Centre, Tirunelveli; his subsequent shifting to CMC Hospital, Vellore on 14.1.1998; conduct of several dialysis for petitioner''s
deceased son; operation conducted at the CMC, Vellore by removing one kidney of the petitioner''s son and sending the same for analysis to the
Laboratory at Taramani, Chennai, are not in dispute. However, before the renal transplantation could be done, petitioner''s son died.
The removing of one kidney and sending the same for analysis to the Laboratory can be treated as surgery conducted. The surgery could not be
completed by transplantation of kidney because of the death of petitioner''s son. The stand taken by the 4th respondent that the petitioner''s son
died even before the treatment could be completed is an unreasonable stand. The Government Scheme introduced in the year 1992 by G.O.Ms.
No. 18 Finance (Allowance-I) Department, dated 9.1.1992 states that the Scheme is introduced to remove the distress caused to the families of
the Government Employees when they are struck by major ailments. The power to sanction the same is delegated to the Heads of Department by
G.O.Ms. No. 846 Finance (Salaries) Department, dated 14.12.1993. Neither in the original Government Order dated 9.1.1992 nor in the
subsequent Government Order dated 14.12.1993 it is stated that if a patient is died, the medical expenses incurred is not payable. If the ailment is
proved the claim is bound to be sanctioned.
The CMC Hospital, Vellore is an approved hospital as per G.O.Ms. No. 846 Finance (Salaries) Department, dated 14.12.1993. The medical
certificate issued by the CMC Vellore was verified by the second respondent and the amount was also sanctioned by him as early as on
14.3.2000. The Director of Agriculture, Chennai-5, by his proceedings dated 7.2.2002, after going through the entire records authorised the
second respondent to sanction the amount as he is the competent authority to sanction the same as per the above referred Government Order.
However, the 4th respondent refused to accept the same and based on his objection the rejection order has been passed which is impugned in this
writ petition.
The object of the scheme is to give financial support to the deserving Government Employees, who contribute towards the Health Fund
Scheme. Such being the object of the Scheme, it is not open to the respondents to deny the benefit to the petitioner, that too after eight long years.
I took a similar view in the decision reported in C. Nagamuthu Vs. State of Tamil Nadu and Others,
In view of the earlier decision of mine, referred above, and having regard to the undisputed facts with regard to the treatment given to the
petitioner''s son, I hold that the impugned order cannot be sustained.
In the result, the writ petition is allowed. The impugned order dated 3.3.2006 is set aside. As the second respondent has already sanctioned
the amount of Rs. 1,00,000/- by order dated 5.12.2003, the 4th respondent is directed to draw and pay the said amount to the petitioner with 9%
interest from 5.12.2003 within a period of four weeks from the date of receipt of copy of this order. No costs.