Region: Asia
Year: 2006
Court: High Court - Madras
Health Topics: Chronic and noncommunicable diseases, Health care and health services, Health systems and financing, Hospitals
Human Rights: Freedom from discrimination
Tags: Access to treatment, Heart disease, Private hospitals, Public hospitals, Reimbursement, Secondary care, Tertiary care
The Petitioner was a retired Works Inspector at the Public Works Department in the State of Tamil Nadu. He was enrolled under the Tamil Nadu Government Employees Health Fund Scheme (the Scheme). He was thus entitled to free medical treatment for himself and his dependents at approved hospitals. In 1998, the Petitioner’s son had to undergo heart surgery at Sree Chitra Tirunal Institute for Medical Science & Technology, Thiruvananthapuram which was in the neighbouring State of Kerala. However the Petitioner’s claim for reimbursement was rejected on the ground that the hospital was not located in Tamil Nadu. The Petitioner showed the Government an earlier order of sanction to another employee even though she underwent surgery at a hospital outside the State of Tamil Nadu. However, the Government refused to accept the Petitioner’s stand. The Petitioner filed a writ petition in the High Court of Madras.
On the issue of whether the government was justified in rejecting the Petitioner’s claims, the Court held in the negative. The Court held that if the Respondent Government had reimbursed another employee who underwent surgery in the same hospital, the Petitioner cannot be denied his rightful claim. The Court held that this action by the Government was violative of Article 14 (the right to equality) of the Constitution.
As to whether the Petitioner was entitled to get fully reimbursed by the Respondent Government, the Court held in the affirmative. The Court held that the Petitioner was a beneficiary of the Scheme and was therefore entitled to medical reimbursement. The Respondent Government was unreasonable in denying him his rightful claim.
“[T]he object of the Scheme is to give financial support to the deserving persons, who contributed towards the Health Fund Scheme. Such being the object of the scheme, it is not open to the respondents to deny the benefit given under the scheme on the ground that the treatment should be taken only in the listed hospitals.” Para. 8.