BEFORE THE DAKSHINA KANNADA DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, MANGALORE
Dated this the 29th JANUARY 2015
PRESENT
SMT. ASHA SHETTY : HON’BLE PRESIDENT
SMT.LAVANYA M. RAI : HON’BLE MEMBER
COMMON ORDER IN
C.C.Nos. 261, 263,271, 287, 288, 289, 298, 313, 320, 321, 382, 383, 386,387, 411, 429, 440, 483/2014 AND 63, 64, 100, 112, 132, & 180/2015
CC.No.261/2014
(Admitted on 18.07.2014)
Jayapraveen S/o Padmayya Gouwda P.
Aged about 43 years,
R/at. Pambaru House, Kolthige Village,
Perlampady Post, Puttur Tq, D.K. …… COMPLAINANT
(Advocate for the Complainant: Sri.Sanjay D)
VERSUS
1. Chief Executive Officer,
Yashaswini Co. Op. Farmers,
Health Care Scheme,
Now at: 6th floor M.S. Building
Co.Op. Secretariat, Ambedkar Veedi,
Bangalore-1.
2. Manager, Medo Assist India Pvt Ltd.,
No. 41, 16th Main, 2nd cross, 2nd stage,
1st Phase, BTN Layout, Bangalore-560076.
3. Chief Executive Officer Kolthige
Sahakari Vyavasayika Sangha N.
Perlampady Post. Puttur Tq, D.K. …. OPPOSITE PARTIES
(Advocate for Opposite Party No.1: Sri Thimmayya P.)
( Opposite Party No.2 and 3 Ex-Parte.)
CC.No.263/2014
(Admitted on 18.07.2014)
Parmeshwara Bhat S/o Late Krishna Bhat
Aged about 61 years, R/at Nettaru Kaje
House Manikkara P.O. Sullia Tq. D.K. …… COMPLAINANT
(Advocate for the Complainant: Sri Sanjay D)
VERSUS
1. Chief Executive Officer,
Yashaswini Co-Op. Farmers,
Health Care Scheme,
6th Floor, M.S. Building,
Co. Op. Secretariat
Ambedkar Veedi,
Bangalore-1.
2. Manager, Bellare Primary Agricultural,
Sahakari Sangha N. Bellare,
Sullia Tq, D.K. 574212. ……. OPPOSITE PARTIES
(Advocate for Opposite Party No.1: Sri Thimmayya P.)
(Opposite Party No.2:Exparte)
CC.No.271/2014
(Admitted on 28.07.2014)
Chennappa Shetty A. S/o Koraga Shetty,
Aged about 72 years,
R/at Peruvaje House, Peruvaje Post,
Sullia Tq., D.K. …… COMPLAINANT
(Advocate for the Complainant: Sri Sanjay D)
VERSUS
1. Chief Executive Officer,
Yashaswini Co-Op. Farmers,
Health Care Scheme,
6th Floor, M.S. Building,
Co. Op. Secretariat
Ambedkar Veedi,
Bangalore-1.
2. Manager, Medi Assist India TPA
Pvt., Ltd., Sri Krishna Aracade, 47/1,
9th cross, 1st Main Road, Sarakki
Industrial layout, 3rd Phase, J.P Nagar Bangalore-78.
3. Secretary, Bellare Primary
Agricultural Co. Operative Society Ltd.,
Sullia Taluka, D.K. ……. OPPOSITE PARTIES
(Advocate for Opposite Party No.1: Sri Thimmayya P.)
(Opposite Party No.2 and 3 :Exparte)
CC.No.287/2014
(Admitted on 16.08.2014)
Raghava Achary
S/o. Giriyappa Achary,
Aged about 49 years,
R/at. Beliyoor Village & Post,
Bantwal Taluk, D.K. …… COMPLAINANT
(Advocate for the Complainant: Sri Sanjay D)
VERSUS
1. Chief Executive Officer,
Yashaswini Co-Op. Farmers,
Health Care Scheme,
6th Floor, M.S. Building,
Co. Op. Secretariat
Ambedkar Veedi,
Bangalore-1.
2. Manager, Medi Assist India TPA
Pvt., Ltd., Sri Krishna Aracade, 47/1,
9th cross, 1st Main Road, Sarakki
Industrial layout, 3rd Phase,
J.P Nagar Bangalore-78.
3. Chief Executive Officer,
Perne agricultural Service
Co. Operative Society Ltd.,
Bantwal Taluk. D.K. ……. OPPOSITE PARTIES
(Advocate for Opposite Party No.1 Sri Thimmayya P.)
(Opposite Party No.2 and 3 :Exparte)
CC.No.288/2014
(Admitted on 16.08.2014)
Smt. Devaki Amma,
W/o. Late Shankaranarayana Bhat,
Aged about 72 years,
R/at. Kanithila House, Ujrupade Post,
Puttur Tq, D.K. . …… COMPLAINANT
(Advocate for the Complainant: Sri Sanjay D)
VERSUS
1. Chief Executive Officer,
Yashaswini Co-Op. Farmers
Health Care Scheme,
6th Floor, M.S. Building,
Co- Op. Secretariat,
Ambedkar Vidhi,
Bangalore-1.
2. Chief Manager,
Balnadu Sahakari Vyavasayika
Sangha N. Beliyoorkatte Post,
Puttur Taluk. D.K. …. OPPOSITE PARTIES
(Advocate for Opposite Party No.1 & 2 : Sri Thimmayya P.)
CC.No.289/2014
(Admitted on 16.08.2014)
Smt. Shyamala
W/o Sheenappa,
Aged about 41 years,
R/at Kayarpadi House,
Uppinangadi, Andethadka Post,
Belthangady Tq, T.K. …… COMPLAINANT
(Advocate for the Complainant: Sri Sanjay D)
VERSUS
1. Chief Executive Officer,
Yashaswini Co-Op. Farmers,
Health Care Scheme,
6th Floor, M.S. Building,
Co. Op. Secretariat
Ambedkar Veedi,
Bangalore-1.
2. Manager,
Yashaswini Managing Director India Health Care,
Managing Director INDIA Health Care Services Pvt., Ltd.,
House No. 8, 9th Cross Road,
Wilson Garden, Near Agadi Hospital, Bangalore-27.
3. Chief Executive Officer,
Uppinangadi Sahakari Vyavasayika
Sangha N. Uppinangady,
Puttur Taluk, D.K. ……. OPPOSITE PARTIES
(Advocate for Opposite Party No.1 & 2: Sri Thimmayya P.)
(Opposite Party No.3: Sri M. Purushothama Bhat)
CC.No.298/2014
(Admitted on 16.08.2014)
Asha Rai K. W/o. Ganesh Rai K.
Aged about 30 years,
R/at. Aramaneguthu House,
Ubaradka Mithoor Post & Village,
Sullia Tq., D.K. …… COMPLAINANT
(Advocate for the Complainant: Sri Sanjay D)
VERSUS
1. Chief Executive Officer,
Yashaswini Co-Op. Farmers,
Health Care Scheme,
6th Floor, M.S. Building,
Co. Op. Secretariat
Ambedkar Veedi,
Bangalore-1.
2. Chief Executive Officer,
Ubaradka Mithoor Primary Agricultural
Co. Opposite Party. Society Ltd.,
Ubaradka Mithoor Post,
Sullia Tq, D.K. ……. OPPOSITE PARTIES
(Advocate for Opposite Party No.1 and 2: Sri Thimmayya P.)
CC.No.313/2014
(Admitted on 30.08.2014)
A.K. Gagan,
S/o A.S. Krishne Gowda,
Aged about 21 years,
R/at Athihalli House
Athihalli Post& Village,
Sakleshpura Tq., Hasana Dist …… COMPLAINANT
(Advocate for the Complainant: Sri.Sanjay D)
VERSUS
1. Chief Executive Officer,
Yashaswini Co. Op. Farmers,
Health Care Scheme,
Now at: 6th floor M.S. Building
Co.Op. Secretariat, Ambedkar Veedi,
Bangalore-1.
2. Chief Executive Officer,
Hongadahalla Primary Agricultural Sahakara
Sangha N., Hethoor Hobli, Sakaleshpura Taluka,
Hasana District.
3. Medical Officer,
A.J. Hospital 7 Research Centre
Kuntikana, Mangalore. …. OPPOSITE PARTIES
(Advocate for Opposite Party No.1: Sri Thimmayya P.)
(Opposite party No. 2 Ex-parte)
(Advocate for Opposite Party No.3: Sri Chandrashekhara Holla K.)
CC.No.320/2014
(Admitted on 06.09.2014)
B. Govinda Bhat,
S/o Achutha Bhat,
Aged about 46 years,
R/at. Dodda Thota House,
Amara Mudnoor Village,
Sullia Tq: D.K. …… COMPLAINANT
(Advocate for the Complainant: Sri Sanjay D)
VERSUS
1. Chief Executive Officer,
Yashaswini Co-Op. Farmers,
Health Care Scheme,
6th Floor, M.S. Building,
Co. Op. Secretariat
Ambedkar Veedi,
Bangalore-1.
2. Secretary,
Chokkady Vyavasaya seva Sahakari,
Sangha N. Kukkujadka Post,
Sullia Taluk, D.K. ……. OPPOSITE PARTIES
(Advocate for Opposite Party No.1 and 2: Sri Thimmayya P.)
CC.No.321/2014
(Admitted on 06.09.2014)
Harish K.S. S/o Shivarama Gowda,
Aged about 31 years,
R/at. Kalgundi House, Balpa Post,
Sullia Tq: D.K. …… COMPLAINANT
(Advocate for the Complainant: Sri Sanjay D)
VERSUS
1. Chief Executive Officer,
Yashaswini Co-Op. Farmers,
Health Care Scheme,
6th Floor, M.S. Building,
Co. Op. Secretariat
Ambedkar Veedi,
Bangalore-1.
2. Chief Executive Officer,
Panja Sahakari Vyavasayika Sangha N.
Panja, Sullia Taluk, D.K. ……. OPPOSITE PARTIES
(Advocate for Opposite Party No.1 and 2: Sri Thimmayya P.)
CC.No.382/2014
(Admitted on 27.09.2014)
Smt. Rajamathi,
W/o. C.B. Neelakumar,
Aged about 47 years,
R/at Chapparamane House,
Banukuli Post, Sagara Tq,.
Shivamogga U.K. …… COMPLAINANT
(Advocate for the Complainant: Sri Sanjay D)
VERSUS
1. Chief Executive Officer,
Yashaswini Co-Op. Farmers,
Health Care Scheme,
6th Floor, M.S. Building,
Co. Op. Secretariat
Ambedkar Veedi,
Bangalore-1.
2. Executive Officer,
Primary Agricultural Co-Operative Society N.,
Kanchikai-Aralagodu-577421
Sagara, Shivamogga Dist. ……. OPPOSITE PARTIES
(Advocate for Opposite Party No.1 : Sri Thimmayya P.)
(Advocate for Opposite Party No.2 : Sri Keshava Nandodi)
CC.No.383/2014
(Admitted on 27.09.2014)
Smt. Susheela W/o Late Anni Banga,
Aged about 67 years,
R/at Shri Mahaveera Nivas,
Andinje Post and Village,
Belthangady Taluk, D.K. …… COMPLAINANT
(Advocate for the Complainant: Sri Sanjay D)
VERSUS
1. Chief Executive Officer,
Yashaswini Co-Op. Farmers,
Health Care Scheme,
6th Floor, M.S. Building,
Co. Op. Secretariat
Ambedkar Veedi,
Bangalore-1.
2. Manager, Medi Assist India TPA
Pvt., Ltd., Sri Krishna Aracade, 47/1,
9th cross, 1st Main Road, Sarakki
Industrial layout, 3rd Phase, J.P Nagar Bangalore-78.
3. Secretary, Venur Co.Op. Agricultural,
Society Ltd., Venur Post,
Belthangady Taluk, D.K.
4. Manager City Hospital research and
Diagnostic Centre Kadri,
Mangalore -03, D.K. ……. OPPOSITE PARTIES
(Advocate for Opposite Party No.1 : Sri Thimmayya P.)
(Opposite party No. 2 : Ex-Parte)
(Opposite party No. 3 : In person)
(Advocate for Opposite Party No.4 : Sri Keshava Nandodi)
CC.No.386/2014
(Admitted on 18.10.2014)
Raghavendra Bhat P,
S/o. Krishna Bhat,
Aged about 43 years,
R/at Vrundavana House,
Kedila Post & Village,
Bantwal Tq., D.K. …… COMPLAINANT
(Advocate for the Complainant: Sri Sanjay D)
VERSUS
1. Chief Executive Officer,
Yashaswini Co-Op. Farmers,
Health Care Scheme,
6th Floor, M.S. Building,
Co. Op. Secretariat
Ambedkar Veedi,
Bangalore-1.
2. Chief Executive Officer,
Kedila Milk Producers Co. Op. Society
N. Kedila Post, Bantwal Tq., D.K. ……. OPPOSITE PARTIES
(Advocate for Opposite Party No.1 : Sri Thimmayya P.)
( Opposite Party No.2 : Ex-Parte )
CC.No.387/2014
(Admitted on 18.10.2014)
Smt. Amruthavani
S/o. Raveendra K.
Aged about 36 years,
R/at. Durganilaya Kuppetti House,
Kalleri Post, Uruvalu Village,
Belthangady Tq., D.K. …… COMPLAINANT
(Advocate for the Complainant: Sri Sanjay D)
VERSUS
1. Chief Executive Officer,
Yashaswini Co-Op. Farmers,
Health Care Scheme,
6th Floor, M.S. Building,
Co. Op. Secretariat
Ambedkar Veedi,
Bangalore-1.
2. Chief Executive Officer,
Thaneerupantha Primary Agricultural,
Co.Op. Society N., Kalleri Post,
Karaya Village,
Belthangady Tq., D.K. 574326 ……. OPPOSITE PARTIES
(Advocate for Opposite Party No.1 : Sri Thimmayya P.)
(Opposite Party No.2 : Ex - Parte)
CC.No.411/2014
(Admitted on 29.10.2014)
Bada S/o Late Loragu,
Aged about 55 years,
R/at. Attole House,
Savanoor village and
Post Puttur Tq., D.K. …… COMPLAINANT
(Advocate for the Complainant: Sri Sanjay D)
VERSUS
1. Chief Executive Officer,
Yashaswini Co-Op. Farmers,
Health Care Scheme,
6th Floor, M.S. Building,
Co. Op. Secretariat
Ambedkar Veedi,
Bangalore-1.
2. Chief Executive Officer,
Savanoor Sahakari Vyavasayika Sangha N.
Savanoor Post, Puttur Taluk. D.K. ……. OPPOSITE PARTIES
(Advocate for Opposite Party No.1 & 2 : Sri Thimmayya P.)
CC.No.429/2014
(Admitted on 15.11.2014)
Mahalinga Patali
S/o Late Thimmappa Patali,
Aged about 62 years,
R/at. Saravu House,
Badagannur Post & Village,
Puttur Tq., DK. …… COMPLAINANT
(Advocate for the Complainant: Sri Sanjay D)
VERSUS
1. Chief Executive Officer,
Yashaswini Co-Op. Farmers,
Health Care Scheme,
6th Floor, M.S. Building,
Co. Op. Secretariat
Ambedkar Veedi,
Bangalore-1.
2. Secretary,
Badagannur Milk Producers Sahakara
Sangha N. Badagannur Post,
Puttur Taluk ……. OPPOSITE PARTIES
(Advocate for Opposite Party No.1 and 2 : Sri Thimmayya P.)
CC.No.440/2014
(Admitted on 29.11.2014)
Kushalappa Gowda,
S/o Chomanna Gowda,
Aged about 59 years,
R/at. Karanje House,
Kankamajalu Post,
Sullia Taluka D.K. …… COMPLAINANT
(Advocate for the Complainant: Sri Sanjay D)
VERSUS
1. Chief Executive Officer,
Yashaswini Co-Op. Farmers,
Health Care Scheme,
6th Floor, M.S. Building,
Co. Op. Secretariat
Ambedkar Veedi,
Bangalore-1.
2. Manager, Medi Assist India TPA Pvt. Ltd.
Sri Krishna Arcade, 47/1, 9th Cross,
1st Main Road, Sarakki Industrial Layout,
3rd Phase, J.P. Nagar, Bangalore-78.
3. Chief Executive officer,
Kanakamajalu Primary Agricultural
Co-op. Society, Kanakamajalu,
Sullia Taluk.D.K.
4. Managar, Athena Hospital,
Falnir Road, Mangalore. ……. OPPOSITE PARTIES
(Advocate for Opposite Party No.1 : Sri Thimmayya P.)
(Opposite party No. 2 : Ex-Parte)
(Advocate for Opposite Party No.3 : Sri Rajesh K.G.)
(Advocate for Opposite Party No.4 : Sri Raghuveer Bhandary M.)
CC.No.483/2014
(Admitted on 12.12.2014)
Hasainar S/o Mahammed,
Aged about 36 years,
R/at. Paramarga House,
Nairmogru Village & Post,
Puttur Tq., D.K. …… COMPLAINANT
(Advocate for the Complainant: Sri Sanjay D)
VERSUS
1. Chief Executive Officer,
Yashaswini Co-Op. Farmers,
Health Care Scheme,
6th Floor, M.S. Building,
Co. Op. Secretariat
Ambedkar Veedi,
Bangalore-1.
2. Chief Executive
Narimogru Vyavasaya Seva Sahakari sangha N,
Narimogru Post,
Puttur Taluk, D.K. ……. OPPOSITE PARTIES
(Advocate for Opposite Party No.1 : Sri Thimmayya P.)
(Opposite party No. 2 : Ex-Parte)
CC.No. 63/2015
(Admitted on 07.02.2015)
Smt. Jayanthi W/o Rama Naika,
Aged about 45 years,
R/at. Kallagudde House,
Ajjavara Post, Sullia Tq., D.K. …… COMPLAINANT
(Advocate for the Complainant: Sri.Sanjay D)
VERSUS
1. Chief Executive Officer,
Yashaswini Co. Op. Farmers,
Health Care Scheme,
Now at: 6th floor M.S. Building
Co.Op. Secretariat, Ambedkar Veedi,
Bangalore-1.
2. Secretary,
Sullia Sahakari Vyavasaya Sangha N
No. 120, Sullia., D.K. …. OPPOSITE PARTIES
(Advocate for Opposite Party No.1: Sri Thimmayya P.)
(Advocate for Opposite Party No.2: Sri Chandrashekhar N.G.)
CC.No. 64/2015
(Admitted on 07.02.2015)
Smt. Jayanthi W/o Rama Naika,
Aged about 45 years,
R/at. Kallagudde House,
Ajjavara Post, Sullia Tq., D.K. …… COMPLAINANT
(Advocate for the Complainant: Sri.Sanjay D)
VERSUS
1. Chief Executive Officer,
Yashaswini Co. Op. Farmers,
Health Care Scheme,
Now at: 6th floor M.S. Building
Co.Op. Secretariat, Ambedkar Veedi,
Bangalore-1.
2. Secretary,
Sullia Sahakari Vyavasaya Sangha N
No. 120, Sullia., D.K. …. OPPOSITE PARTIES
(Advocate for Opposite Party No.1: Sri Thimmayya P.)
(Advocate for Opposite Party No.2: Sri Chandrashekhar N.G.)
CC.No.100/2015
(Admitted on 13.03.2015)
Gangayya Poojary
S/o. Late. Kanthappa Poojary,
Aged about 74 years,
R/at Dembale House,
Kanchana Post, Bajathuru Village,
Bantwal Tq: D.K. …… COMPLAINANT
(Advocate for the Complainant: Sri Sanjay D)
VERSUS
1. Chief Executive Officer,
Yashaswini Co-Op. Farmers,
Health Care Scheme,
6th Floor, M.S. Building,
Co. Op. Secretariat
Ambedkar Veedi,
Bangalore-1.
2. Chief Executive Officer,
Murthedarara Seva Sahakari Sangha N.
Uppinangady, Puttur Taluk 574 241. ……. OPPOSITE PARTIES
(Advocate for Opposite Party No.1 & 2: Sri Thimmayya P.)
CC.No.112/2015
(Admitted on 20.03.2015)
Smt. Mookambika
W/o Late K. Krishna Bhat,
Aged about 72 years,
R/at. Danpane House,
Nettana Post, Bilinele Village,
Puttur Tq., D.K. …… COMPLAINANT
(Advocate for the Complainant: Sri Sanjay D)
VERSUS
1. Chief Executive Officer,
Yashaswini Co-Op. Farmers,
Health Care Scheme,
6th Floor, M.S. Building,
Co. Op. Secretariat
Ambedkar Veedi,
Bangalore-1.
2. Manager,
Bilinele Sahakari Vyavasayika Sangha N.
Nettana Post,
Puttur Tq, D.K. ……. OPPOSITE PARTIES
(Advocate for Opposite Party No.1 Sri Thimmayya P.)
(Opposite Party No.2 :Ex-Parte)
CC.No.132/2015
(Admitted on 20.04.2015)
Monappa Naika P.
S/o. Late Ammu Naika,
Aged about 55 years,
R/at. Sadikukku House,
Budoli Post & Village,
Bantwal Taluk, D.K. …… COMPLAINANT
(Advocate for the Complainant: Sri Sanjay D)
VERSUS
1. Chief Executive Officer,
Yashaswini Co-Op. Farmers
Health Care Scheme,
6th Floor, M.S. Building,
Co- Op. Secretariat,
Ambedkar Vidhi,
Bangalore-1.
2. Chief Executive Officer,
Neralakatte Vyavasaya,
Seva Sahakari Sangha N.
Neralakatte, Bantwal Tq., D.K.
3. Manager,
Pragathi Speciality Hospital,
Main Road, Bolwar,
Puttur Taluk, D.K. …. OPPOSITE PARTIES
(Advocate for Opposite Party No.1 : Sri Thimmayya P.)
(Advocate for Opposite Party No.2 : Sri J.Narayan Prasad.)
(Opposite Party No. 3 : Ex-Parte)
CC.No.180/2015
(Admitted on 02.06.2015)
Sathyanarayana Prasad
S/o. late Mahalinga Bhat,
Aged about 47 years,
R/at. Suspetty House,
Kavu Post, Maadnoor Village,
Puttur Tq., D.K. …… COMPLAINANT
(Advocate for the Complainant: Sri Sanjay D)
VERSUS
1. Chief Executive Officer,
Yashaswini Co-Op. Farmers,
Health Care Scheme,
6th Floor, M.S. Building,
Co. Op. Secretariat
Ambedkar Veedi,
Bangalore-1.
2. Authorized Signatory,
Kavu Primary Agricultural Co-Op. Society,
Kavu Post, Puttur Tq., D.K. ……. OPPOSITE PARTIES
(Advocate for Opposite Party No.1 & 2: Sri Thimmayya P.)
ORDER DELIVERED BY HON’BLE PRESIDENT
SMT. ASHA SHETTY:
I. 1. All the Complainants filed the above complaints under Section 12 of the Consumer Protection Act alleging deficiency in service against the Opposite Parties claiming similar reliefs. In order to save the time as well as for the sake of convenience we have taken up all the cases together and passed common order as under:
The brief facts of the case are as under:
The Complainants in C.C.Nos. 261,263,271,287,288,289,298, 313,320,321,382,383,386,387,411,429,440,483/2014, and 63, 64, 100, 112, 132, & 180 /2015 all are members of Yashaswini Co-operative farmers health care scheme and during the validity of the membership they have taken medical treatment in different hospitals situated in D.K. District and one of the complainant in Bangalore and spent certain sum of money for the medical treatments as mentioned in their respective complaints.
However, we have taken up in detail as under:-
The Complainant in C.C.No.261/2014 claimed that he had taken treatment in City Hospital, Puttur for sudden headache and Vomiting and admitted as an inpatient on 08.10.2012 undergone operation discharged on 05.11.2012 and spent Rs.3,79,334/-, but the Opposite Party not reimbursed the medical expenses spent by the Complainant and contended that she is entitled for the medical bills and the Opposite Party is liable to reimburse the medical expenses.
The Complainant in C.C.No. 288/2014 claimed that she had taken treatment in Sharada Nethralaya Kallare, Puttur for Phacoemulsification operation for cataract and admitted as an inpatient on 26.11.2013 undergone operation discharged on 23.12.2013 and spent Rs.10,822/-, but the Opposite Party not reimbursed the medical expenses spent by the Complainant and contended that she is entitled for the medical bills and the Opposite Party is liable to reimburse the medical expenses.
The Complainant in C.C.No. 289/2014 claimed that she had taken treatment in Mangala Kidny Foundation Mangalore for Thyroidectomy operation and admitted as an inpatient on 24.03.2014 undergone operation discharged on 29.03.2014 and spent Rs.39,268/-, but the Opposite Party not reimbursed the medical expenses spent by the Complainant and contended that she is entitled for the medical bills and the Opposite Party is liable to reimburse the medical expenses.
The Complainant in C.C.No. 298/2014 claimed that she had taken treatment in Puttur city Hospital for Ectopic Pregnancy and admitted as an inpatient on 08.03.2013 undergone operation discharged on 13.03.2013 and spent Rs.19,254/-, but the Opposite Party not reimbursed the medical expenses spent by the Complainant and contended that she is entitled for the medical bills and the Opposite Party is liable to reimburse the medical expenses.
The Complainant in C.C.No. 313/2014 claimed that he had taken treatment in A.J. Hospital Mangalore for Chronic Calcific Pancreatitis and admitted as an inpatient on 03.02.2014 undergone operation discharged on 20.02.2014 and spent Rs.70,593/-, but the Opposite Party not reimbursed the medical expenses spent by the Complainant and contended that she is entitled for the medical bills and the Opposite Party is liable to reimburse the medical expenses.
The Complainant in C.C.No. 320/2014 claimed that he had taken treatment in Dhanvanthari Hospital Puttur for Laparoscopic Appendisectomy and admitted as an inpatient on 02.10.2013 undergone operation discharged on 07.10.2013 and spent Rs.31,000/-, but the Opposite Party not reimbursed the medical expenses spent by the Complainant and contended that she is entitled for the medical bills and the Opposite Party is liable to reimburse the medical expenses.
The Complainant in C.C.No. 321/2014 claimed that he had taken treatment in Dhanvanthari Hospital Puttur for Caesarian Operation and admitted as an inpatient on 15.11.2012 undergone operation discharged on 10.11.2012 and spent Rs.15,040/-, but the Opposite Party not reimbursed the medical expenses spent by the Complainant and contended that she is entitled for the medical bills and the Opposite Party is liable to reimburse the medical expenses.
The Complainant in C.C.No. 382/2014 claimed that she had taken treatment in Dharmasthala Manjunatheshwara Hospital Ujire fork Thyroidectomy and admitted as an inpatient on 12.01.2014 undergone operation discharged on 17.01.2014 and spent Rs.27,498/-, but the Opposite Party not reimbursed the medical expenses spent by the Complainant and contended that she is entitled for the medical bills and the Opposite Party is liable to reimburse the medical expenses.
The Complainant in C.C.No. 383/2014 claimed that she had taken treatment in City Hospital Mangalore for Fracture Shaft Right Femur and admitted as an inpatient on 26.01.2012 undergone operation discharged on 08.02.2012 and spent Rs.57,325/-, but the Opposite Party not reimbursed the medical expenses spent by the Complainant and contended that she is entitled for the medical bills and the Opposite Party is liable to reimburse the medical expenses.
The Complainant in C.C.No. 386/2014 claimed that she had taken treatment in Mahaveera Medical Centre Puttur for Inguinal Hernia and admitted as an inpatient on 06.10.2013 undergone operation discharged on 09.10.2013 and spent Rs.23,343/-, but the Opposite Party not reimbursed the medical expenses spent by the Complainant and contended that she is entitled for the medical bills and the Opposite Party is liable to reimburse the medical expenses.
The Complainant in C.C.No. 387/2014 claimed that she had taken treatment in Dhanavanthri Hospital Puttur for Caesarian and Tubectomy and admitted as an inpatient on 15.03.2013 undergone operation discharged on 22.03.2013 and spent Rs. 22,745/-, but the Opposite Party not reimbursed the medical expenses spent by the Complainant and contended that she is entitled for the medical bills and the Opposite Party is liable to reimburse the medical expenses.
The Complainant in C.C.No. 411/2014 claimed that he had taken treatment in Dhanavanthri Hospital Puttur, for Bull gore injury to left thigh and admitted as an inpatient on 22.02.2014 undergone operation discharged on 27.02.2014 and spent Rs. 9,190/-, but the Opposite Party not reimbursed the medical expenses spent by the Complainant and contended that she is entitled for the medical bills and the Opposite Party is liable to reimburse the medical expenses.
The Complainant in C.C.No. 429/2014 claimed that he had taken treatment in Dhanavanthri Hospital Puttur, for Sickle fall on left shoulder and admitted as an inpatient on 13.11.2013 undergone operation discharged on 16.11.2013 and spent Rs. 5,230/-, but the Opposite Party not reimbursed the medical expenses spent by the Complainant and contended that she is entitled for the medical bills and the Opposite Party is liable to reimburse the medical expenses.
The Complainant in C.C.No. 483/2014 claimed that he had taken treatment in Dhanavanthri Hospital Puttur, for URS &DJS stenting and admitted as an inpatient on 19.03.2014 undergone operation discharged on 22.03.2014 and spent Rs. 24,290/-, but the Opposite Party not reimbursed the medical expenses spent by the Complainant and contended that she is entitled for the medical bills and the Opposite Party is liable to reimburse the medical expenses.
The Complainant in C.C.No. 440/2014 claimed that he had taken treatment in Athena Hospital Mangalore, for Loss of hearing and admitted as an inpatient on 03.07.2013 undergone operation discharged on 08.07.2013 and spent Rs. 35,695/-, but the Opposite Party not reimbursed the medical expenses spent by the Complainant and contended that she is entitled for the medical bills and the Opposite Party is liable to reimburse the medical expenses.
The Complainant in C.C.No.263/2014 claimed that he had taken treatment in Dhanvanthari Hospital, Puttur for Irreducible Incisional Hernia from Previous LSCS midline Infraumbilical Scar and admitted as an inpatient on 16.01.2013 undergone operation discharged on 23.01.2013 and spent Rs.39,440/-, but the Opposite Party not reimbursed the medical expenses spent by the Complainant and contended that she is entitled for the medical bills and the Opposite Party is liable to reimburse the medical expenses.
The Complainant in C.C.No.271/2014 claimed that he had taken treatment in Mangala Hospital, Kidny Foundation for Ca Right Border Tongue Stage -3 and admitted as an inpatient on 11.09.2013 undergone operation discharged on 23.09.2013 and spent Rs.66,968/-, but the Opposite Party not reimbursed the medical expenses spent by the Complainant and contended that she is entitled for the medical bills and the Opposite Party is liable to reimburse the medical expenses.
The Complainant in C.C.No.287/2014 claimed that he had taken treatment in K.M.C. Hospital Mangalore for C2-C3 Schwannoma and admitted as an inpatient on 21.10.2013 undergone operation discharged on 31.10.2013 and spent Rs. 71,848/-, but the Opposite Party not reimbursed the medical expenses spent by the Complainant and contended that she is entitled for the medical bills and the Opposite Party is liable to reimburse the medical expenses.
The Complainant in C.C.No.63/2015 claimed that she had taken treatment in Dhanvanthari Hospital, Puttur for Abdominal Hysterectomy and admitted as an inpatient on 18.06.2014 undergone operation discharged on 22.06.2014 and spent Rs.1,060/-, but the Opposite Party not reimbursed the medical expenses spent by the Complainant and contended that she is entitled for the medical bills and the Opposite Party is liable to reimburse the medical expenses.
The Complainant in C.C.No.64/2015 claimed that he had taken treatment in Dhanvanthari Hospital, Puttur for Sigmoid Colostomy and admitted as an inpatient on 30.06.2014 undergone surgery discharged on 13.07.2014 and spent Rs.33,140/-, but the Opposite Party not reimbursed the medical expenses spent by the Complainant and contended that she is entitled for the medical bills and the Opposite Party is liable to reimburse the medical expenses.
The Complainant in C.C.No.100/2015 claimed that he had taken treatment in Dhanvanthari Hospital, Puttur for TURP operation and admitted as an inpatient on 01.09.2014 undergone surgery discharged on 05.09.2014 and spent Rs.27,040/-, but the Opposite Party not reimbursed the medical expenses spent by the Complainant and contended that he is entitled for the medical bills and the Opposite Party is liable to reimburse the medical expenses.
The Complainant in C.C.No.112/2015 claimed that she had taken treatment in Dhanvanthari Hospital, Puttur for Total Laparoscopic Hystrectomy operation and admitted as an inpatient on 11.10.2013 undergone surgery discharged on 16.10.2013 and spent Rs.56,070/-, but the Opposite Party not reimbursed the medical expenses spent by the Complainant and contended that he is entitled for the medical bills and the Opposite Party is liable to reimburse the medical expenses.
The Complainant in C.C.No.132/2015 claimed that he had taken treatment in Pragathi Speciality Hospital Bolwar, Puttur Taluk for Gastrectomy operation and admitted as an inpatient on 06.02.2014 undergone surgery discharged on 18.02.2014 and spent Rs.47,712/-, but the Opposite Party not reimbursed the medical expenses spent by the Complainant and contended that he is entitled for the medical bills and the Opposite Party is liable to reimburse the medical expenses.
The Complainant in C.C.No.180/2015 claimed that he had taken treatment in Dhanavanthari Hospital Puttur for Circumcision, Hernia and TURP and admitted as an inpatient on 22.08.2014 undergone surgery discharged on 04.09.2014 and spent Rs.72,740/-, but the Opposite Party not reimbursed the medical expenses spent by the Complainant and contended that he is entitled for the medical bills and the Opposite Party is liable to reimburse the medical expenses.
It is contended that, the Opposite Parties are liable to reimburse the medical expenses under the Yashaswini Farmers Health Care scheme, but the Opposite Parties not reimbursed medical expenses spent by them till this date. Further in complainants contended that they are not aware of the terms and conditions of the above said scheme and also not aware the name of the network hospitals, how preauthorization is to be obtained, which are the diseases covered, who has to obtain preauthorization and what are the preconditions. However it is contented that all the Complainants were taken treatment during the existence of the above said membership under the scheme, non-payment of the entire medical expenses by the Opposite Parties under the farmers health care scheme amounts to deficiency in service. Feeling aggrieved by the above, the above complaints are filed before this Forum under Section 12 of the Consumer Protection Act 1986 (herein after referred to as ‘the Act’) seeking direction from this Forum to the Opposite Parties to pay the entire medical expenses spent by them respectively mentioned in their complaints and also sought for compensation and cost of the proceedings.
II. 1. Version notice served to the Opposite Parties by R.P.A.D. in all the complaints. The chief executive officer Yashaswini cooperative farmers health care scheme Bangalore filed similar version in all the complaints wherein stated that Yashaswini cooperative farmer health care scheme is not a insurance, it is a trust formed by the Government of the Karnataka to help the Co-operative farmers in the year 2003. It is also stated that, in order to avail the benefits of the Yashaswini Co-operative Farmers Health Care Scheme, the members have to follow the procedures prescribed under the scheme. To claim any amount under the scheme, the member has to be operated/taken treatment in any of the network hospitals earmarked by the trust, if the member treated elsewhere this Opposite Party is not liable to pay any amount to the member for breach of the terms of the procedure prescribed under the scheme. It is also stated that the receipt issued to the members is not vague and that the conditions are clearly mentioned in the back side of the receipt. The some of the Complainants are not taken treatment in network hospital earmarked by trust and hence Opposite Party is not liable to reimburse the claim. It is further stated that 1st Opposite Party fixed the amount for each surgery and the same is paid directly to the hospital and the same has been accepted by them and denied the deficiency and prayed for dismissal of the complaint. Further stated that as per the guidelines it is clearly mentioned that package rates have been fixed for all the surgeries under the scheme. By considering the above the Yashaswini Co-Operative Health Care Trust sanctioned the amount denied the deficiency and prayed for dismissal of the complaint. And also in C.C.No.45/2014 the Opposite Party i.e. Yashashwini co-operative health care trust they have paid Rs.29,500/- towards the medical reimbursement and also contended that there is no deficiency and prayed for dismissal of the complaint.
In CC.No.15, 53, 54/2014, 294, 295/2013 the Opposite Party No.2 despite of receiving version notice neither appeared nor contested the case before this FORA. Hence, we have proceeded exparte as against the Opposite Party No.2. Postal acknowledgement marked as Court Doc.No.1 to 5. And in CC.No. 45/2014 the Opposite Party No.2 and 3 despite of receiving version notice neither appeared nor contested the case before this FORA. Hence, we have proceeded exparte as against the Opposite Party No.2 & 3. Postal acknowledgement marked as Court Doc.No.6 & 7.
III. 1. In support of the above complaints, all the respective Complainants are examined as CW-1 and answered the interrogatories served on them and produced documents got marked under the ‘Ex.C’ series detailed in the annexure here below. Opposite Parties also examined and filed their counter affidavits and answered the interrogatories served on them and produced documents got marked under the ‘Ex R’ series detailed in the annexure herebelow.
In view of the above said facts, the points now that arise for our consideration in this case are as under:
Whether the Complainants proves that the Opposite Parties committed deficiency in service?
If so, whether the Complainants are entitled for the reliefs claimed?
What order?
We have considered the notes/oral arguments submitted by the learned counsels and also considered the materials that was placed before this Forum and answer the points are as follows:
Point No.(i): Affirmative.
Point No.(ii) to (iii): As per the final order.
REASONS
IV. 1. POINTS No. (i) to (iii):
In the above cases, the facts which are not in dispute is that, the Yashaswini Scheme is a benevolent Insurance farmers Healthcare Scheme introduced by the Government of Karnataka to provide medical assistance to poor Co-operative farmers and their family members in the year 2003. It is also admitted fact that the Complainants along with their respective family members became the members of the Yashaswini Co-operative Farmers Health Care Scheme by paying the prescribed premium offered by the Opposite Parties. In support of the above, all the Complainants produced membership receipts before this authority i.e. marked mentioned in “Ex.C” series and the same were valid for one year. It is also not disputed that during the validity of the membership Complainants and their family members as mentioned in the respective complaints were taken treatment in different hospitals mentioned in the complaints. Further it is admitted fact that the 1st Opposite Party i.e., a trust formed by the Government of Karnataka undertaken to reimburse the medical expenses of the Yashaswini Healthcare Scheme members.
Now the points are in dispute between the parties before this FORA is that, the Complainants contended that, the Complainants as well as their family members mentioned in the respective complaints taken treatment in the hospitals and produced the medical bills before the Opposite Parties, but the Opposite Parties not reimbursed the medical expenses spent by them till this date. And some of the Complainants contended that the membership receipt issued by the Opposite Parties is vague and do not contain the details of the network hospitals and other conditions. Feeling aggrieved by the above the present complaints came to be filed before this FORA.
The Opposite Party No.1 interalia contended that, to avail benefit under Yashaswini Scheme the beneficiary’s are to follow the procedures prescribed under the scheme. In order to claim any amount under the scheme, the members have to undergo operation in any of the network hospital earmarked by the trust. And further contended that, the receipt issued by the Opposite Party clearly discloses the terms and conditions.
We have heard the counsels for the parties and perused the oral as well as documentary evidence available on record, wherein, the Ex C1 produced in all the complaints are the membership receipts issued by the Yashaswini Co-Operative Farmers Healthcare Scheme Bangalore. The above receipts shows that the Complainants along with their respective family members became the members of the Yashaswini farmers health care Scheme introduced by the Government of Karnataka and they are the beneficiaries under the scheme. In all the complaints the Complainants produced the hospital records supported by medical bills as well as admissions of the Opposite Parties shows that all the Complainants taken medical treatment in one or the other hospitals mentioned in their respective complaints. Further to substantiate the amount spent for the medical treatment all the Complainants produced copy of the medical bills in all the cases. Further discharge summary issued by the hospitals produced by the Complainants in some cases shows that the Complainants taken medical treatment in different hospitals situated in D.K. District, Karnataka State.
However, we have noted that, in Ex C1 i.e. receipts issued by the Opposite Party in all the cases not mentioned/found the detailed terms and conditions of the scheme/policy and also with regard to obtaining of pre-authorization before taking treatment or any other procedure supposed to be adopted by the members or the hospitals. Further there is no details of name of the listed network hospitals or list of operation and the amount fixed on the operation etc etc. But, Hon’ble State commission in appeal No. 419/2013 wherein it is observed as under:-
In para No. 19:- At the outset it is seen that the scheme of the appellant does not fall within the ambit of Insurance Act, as it is the scheme managed by the trust for the benefit of the farmers within the ambit and scope of the trust so formed. Hence the complainant cannot claim as a matter of right for reimbursement of the amount spent by him from the opposite party No. 1 appellant.
In para No. 20:- With regard to the contention of the complainant that he was not aware of the restrictions imposed under the scheme formed by the trust, it is seen that the complainant has got marked the receipts as Ex C-1 to C2.
In para No. 22:- On perusal of the deed of trust of the first Opposite Party’s it is seen that in Appendix-1 medical benefit is defined as hereunder:-
“MEDICAL BENEFITS shall mean in-patient hospitalization including the related surgeries as notified by the trust, which can be availed by the members (Subject to the Maximum Eligibility) at any of the network Hospital(s) under the Scheme"
And “Cost of surgery” shall mean the consolidated package amount as fixed by the trust in connection with the surgery.
In para No. 24:- As discussed supra the scheme is not on par with any insurance policy. The observation made by the District Forum in that regard is not proper. The observation made by the District forum that the Opposite Party cannot overlook the Regulation laid down under the insurance Regulatory and Development authority (Protection of Policy Holder’s Interest), Regulations, 2002 etc., is also not proper. Infact, the District Forum totally misread the scheme to be one under the insurance policy and deemed it fit to allow the complaint which prima – facie wrong approach.
In view of the above observation, by applying the above ratio we are dismissing the complaint as there is no merits and the principals laid down in the above appeal applicable to all the cases. Therefore, all the complaints dismissed as there is no merits.
ORDER
The complaint is dismissed. No order as to costs.
The copy of this order as per the statutory requirements be forwarded to the parties and therefore the file be consigned to record.
(Page No.1 to dictated to the Stenographer typed by him, revised and pronounced in the open court on this the 29th day of JANUARY 2016.)
PRESIDENT MEMBER
(SMT. ASHA SHETTY) (SMT. LAVANYA M.RAI)
D.K. District Consumer Forum D.K. District Consumer Forum
Mangalore. Mangalore.
ANNEXURE
Witnesses examined on behalf of the Complainants:
CW1: Jayapraveen – Complainant in CC.No.261/2014.
CW1: Smt. Devaki Amma – Complainant in CC.No.288/2014.
CW1: Smt. Shyamala – Complainant in CC.No.289/2014.
CW1: Asha Rai K – Complainant in CC.No.298/2014.
CW1: A.K. Gagan – Complainant in CC.No.313/2014.
CW1: Smt. Susheela – Complainant in CC.No.383/2014.
CW1: Sri. Ragavendra Bhat.P – Complainant in CC.No.386/2014.
CW1: Smt. Amruthavani – Complainant in CC.No.387/2014.
CW1: Sri. Bada – Complainant in CC.No.411/2014.
CW1: Sri. Mahalinga Patali – Complainant in CC.No.429/2014.
CW1: Sri. Hasainar – Complainant in CC.No.483/2014.
CW1: Sri. Kushalappa Gowda – Complainant in CC.No.440/2014.
CW1: Sri. Parameshwara Bhat – Complainant in CC.No.263/2014.
CW1: Sri Chennappa Shetty A. – Complainant in CC.No.271/2014.
CW1: Sri Raghava Achary – Complainant in CC.No.287/2014.
CW1: B. Govinda Bhat – Complainant in CC.No.320/2014.
CW1:Sri Harish K.S. – Complainant in CC.No.321/2014.
CW1: Smt. Rajamathi – Complainant in CC.No.382/2014.
CW1: Smt. Jayanthi – Complainant in CC.No.63/2015.
CW1: Smt. Jayanthi – Complainant in CC.No.64/2015.
CW1: Sri Gangayya Poojary – Complainant in CC.No.100/2015.
CW1: Smt. Mookambika – Complainant in CC.No.112/2015.
CW1: Sri. Manappa Naika.P. – Complainant in CC.No.132/2015.
CW1: Sathyanarayana Prasad – Complainant in CC.No.180/2015.
Documents produced on behalf of the Complainant in CC:No.261/2014:
Ex C1 – 30.06.2012: Copies of the membership receipts (3).
Ex C2 – 17.12.2012: Copy of the claim letter.
Ex C3 – 22.02.2013: Repudiation letter sent by 1st O.P.
Ex C4 – 28.11.2012: copy of the discharge summary.
Ex C5 – 05.11.2012: Copy of the discharge summary.
Ex C6 _ 12.02.2013: Copies of the bills (51)
Ex C7 – 25.03.2013: O/c of regd. Lawyer’s notice
Ex C8 – 05.04.2013: Reply of 1st Opposite Party.
Ex C9 – 28.03.2013: Postal Acknowledgment 2nd Opposite Party
EXC10-28.03.2013: Reply of 3rd Opposite Party.
Documents produced on behalf of the Complainant in CC:No.263/2014:
Ex C1 – 22.03.2012: Copy of the membership.
Ex C2 – 25.01.2013: Copy of the claim sent to the 1st Opposite Party.
Ex C3 – 25.02.2013: Repudiation letter sent by 1st O.P with 18 doct.
Ex C4 – 08.03.2013: O/c of the regd notice.
Ex C5 – 16.04.2013: Reply of 1st Opposite Party.
Ex C6 _ 11.03.2013: Postal acknowledgment of 2nd Opposite Party.
Documents produced on behalf of the Complainant in CC:No.271/2014:
Ex C1 – 11.09.2013: Copy of the membership receipt.
Ex C2 – 23.09.2013: Original of the Discharge Summary.
Ex C3 – 23.09.2013: Copies of the bills.
Ex C4 – 06.02.2014: O/c of the regd lawyer’s notice.
Ex C5 – 10.03.2014: Reply of 1st Opposite Party.
Ex C6 - 10.02.2014: Postal acknowledgment of 2nd & 3rd Opposite Parties.
Ex C7- 19.9.2014: Pre authorizations(2)
Ex C8- 09.09.2014: Copy of MRI Scan.
Documents produced on behalf of the Complainant in CC:No.287/2014:
Ex C1 – 18.09.2013: Copy of the membership receipt.
Ex C2 – 31.10.2013: Copy of the Discharge Summary.
Ex C3 – 31.10.2013: Copy of the bill.
Ex C4 – 06.02.2014: O/c of the regd lawyer’s notice.
Ex C5 – 10.03.2014: Reply of 1st Opposite Party.
Ex C6 - 10.02.2014: Postal acknowledgment of 2nd Opposite Party.
Ex C7- 11.2.2014: Postal Receipt of 3rd O.P.
Documents produced on behalf of the Complainant in CC:No.288/2014:
Ex C1 – 18.09.2013: Copy of the membership receipt.(2)
Ex C2 – 23.12.2013: O/o of the claim sent to the 1st O.P.
Ex C3 – 21.01.2014: Repudiation letter with 6 documents.
Ex C4 – 28.02.2014: O/c of the regd notice.
Ex C5 – 09.03.2014: Reply of 1st Opposite Party.
Ex C6 - 28.03.2014: Reply of the 2nd O.P.
Documents produced on behalf of the Complainant in CC:No.289/2014:
Ex C1 – 15.10.2013: Copy of the membership receipt.(2)
Ex C2 – 27.03.2014: Original Discharge summary.
Ex C3 – : Originals of the bills(7).
Ex C4 – 29.03.2014: Authorization letter by2nd O.P.
Ex C5 – 03.05.2014: O/c of the regd lawyer’s notice.
Ex C6 - 06.05.2014: Postal acknowledgments of 1st & 2nd O.P.
Ex C7- 05.05.2014: Postal acknowledgments of 3rd O.P.
Documents produced on behalf of the Complainant in CC:No.298/2014:
Ex C1 – 19.04.2012: Copy of the membership receipt.(2)
Ex C2 – 13.03.2013: Copy of the discharge summary.
Ex C3 – 13.03.2013: Copies of the bills (14).
Ex C4 – 08.03.2013: Copy of the Ultra Sonography.
Ex C5 – 29.05.2014: Office copy of the regd lawyer’s notice.
Ex C6 - 02.06.2014: Postal Acknowledgment of 1st O.P.
Ex C7 – 04.06.2014: Reply of the 2nd O.P.
Documents produced on behalf of the Complainant in CC:No.313/2014:
Ex C1 – 11.11.2013: Copies of the membership receipt.(2)
Ex C2 – 21.02.2014: O/c of the claim sent to the 1st O.P.
Ex C3 – 04.03.2014: Letter issued by the 1st O.P.
Ex C4 – 20.02.2014: Copy of the discharge summary.
Ex C5 - 20.02.2014: Copies of the bills (28).
Ex C6 – 04.04.2014: O/c of regd. notice.
Ex C7 – 11.04.2014: Postal acknowledgment of the 1st O.P.
Ex C8 – 25.04.2014: Postal Acknowledgment of the 2nd O.P.
Ex C9 – 10.04.2014: Postal Acknowledgment of the 3rd O.P.
Documents produced on behalf of the Complainant in CC:No.320/2014:
Ex C1 – 30.08.2013: Copy of the membership receipt
Ex C2 – 19.10.2013: O/c of the claim sent to the 1st O.P.
Ex C3 – 26.10.2013: Postal acknowledgment 1st O.P.
Ex C4 – 25.10.2013: Postal Acknowledgment 2nd O.P.
Ex C5 - 07.10.2013: Copy of the discharge summary.
Ex C6 – 07.10.2013: Copies of the bills (10).
Ex C7 – 18.01.2014: O/c of the regd notice.
Ex C8 – 20.02.2014: Reply of the 1st & 2nd O.Ps.
Documents produced on behalf of the Complainant in CC:No.321/2014:
Ex C1 – 30.07.2012: Copy of the membership receipt.
Ex C2 – 28.11.2012: O/c of the claim sent to the 1st O.P.
Ex C3 – 25.02.2013: Letter of repudiation by the 1st O.P.
for returning the claim papers with annexures (13).
Ex C4 – 07.05.2013: O/c of the regd lawyer’s notice.
Ex C5 - 08.05.2013: Postal Acknowledgment 2nd O.P.
Ex C6 – 04.06.2013: Reply of the 1st O.P.
Documents produced on behalf of the Complainant in CC:No.382/2014:
Ex C1 – 05.11.2013: Copy of the membership receipt.
Ex C2 – 17.01.2014: Copy of the discharge summary.
Ex C3 – 17.02.2014: Copies of the bill (11).
Ex C4 – 03.07.2014: O/c of the regd. Notice sent to the Opposite Party. Party.
Ex C5 - 08.07.2014: Postal Acknowledgment of 1st O.P.
Ex C6 – 07.07.2014: Postal acknowledgment of 2nd O.P.
Documents produced on behalf of the Complainant in CC:No.383/2014:
Ex C1 – 29.04.2011: Copy of the membership receipts.(2)
Ex C2 – 08.02.2012: Copy of the Discrge summy .
Ex C3 – 08.02.2012: Copies of the bills (15) .
Ex C4 – 14.05.2014: O/c of the regd lawyer’s notice.
Ex C5 - 20.05.2014: Postal Acknowledgment of 1st O.P.
Ex C6 – 19.05.2014: Postal Acknowledgment of the 2nd O.P.
Ex C7 – 16.05.2014: Postal acknowledgment of the 3rd O.P.
Ex C8 – 26.06.2014: Reply of 4th O.P.
Documents produced on behalf of the Complainant in CC:No.386/2014:
Ex C1 – 31.08.2013: Copy of the membership receipt.
Ex C2 – 30.10.2013: O/c of the claim sent to the 1st O.P.
Ex C3 – 27.11.2013: Repudiation letter by the 1st O.P. with 12 docts.
Ex C4 – 06.01.2014: O/c of the regd notice.
Ex C5 - 11.01.2014: Postal Acknowledgment of 2nd O.P.
Ex C6 – 08.02.2014: Reply of 1st O.P.
Documents produced on behalf of the Complainant in CC:No.387/2014:
Ex C1 – 05.06.2012: Copy of the membership receipts.
Ex C2 – 01.04.2013: O/c of the claim sent to the 1st O.P.
Ex C3 – 10.04.2013: Repudiation letter by the 1st O.P. with 11 docts.
Ex C4 – 27.05.2013: O/c of the regd notice.
Ex C5 - 06.07.2013: Reply of 1st O.P
Ex C6 – 28.05.2013: Postal Acknowledgment of 2nd O.P.
Documents produced on behalf of the Complainant in CC:No.411/2014:
Ex C1 – 08.10.2013: Copy of the membership receipts (2).
Ex C2 – 04.04.2014: O/c of the claim sent to the 1st O.P.
Ex C3 – 25.04.2014: Repudiation letter by the 1st O.P. with 8 docts.
Ex C4 – 20.06.2014: O/c of the regd notice.
Ex C5 - 24.06.2014: Postal Acknowledgment of 1st O.P.
Ex C6 – 21.06.2014: Postal Acknowledgment of 2nd O.P.
Documents produced on behalf of the Complainant in CC:No.429/2014:
Ex C1 – 30.08.2013: Copy of the membership receipts.1
Ex C2 – 21.11.2013: O/c of the claim sent to the 1st O.P.
Ex C3 – 30.11.2013: Postal Acknowledgment 1st O.P.
Ex C4 – 27.11.2013: Postal Acknowledgment 2nd O.P.
Ex C5 - 16.11.2013: Copy of the discharge summary.
Ex C6 – 16.11.2013: Copies of the bills (5).
Ex C7 – 23.05.2014: O/c of the regd notice.
Ex C8 – 26.05.2014: Postal acknowledgment of 1st O.P.
Ex C9 - 24.05.2014: Postal Acknowledgment of 2nd O.P.
Documents produced on behalf of the Complainant in CC:No.440/2014:
Ex C1 – 30.10.2013: Copy of the membership receipts.
Ex C2 – 08.07.2013: Copies of the bills (3).
Ex C3 – 15.09.2014: O/c of the regd lawyer’s notice.
Ex C4 – 19.09.2014: Postal Acknowledgment 1nd and 2nd O.P’s (2).
Ex C5 - 25.09.2014: Reply of 3rd O.P.
Ex C6 – 20.09.2014: Reply of 4th O.P.
Documents produced on behalf of the Complainant in CC:No.483/2014:
Ex C1 – 26.10.2013: Copy of the membership receipt.
Ex C2 – 16.04.2014: O/c of the claim sent to the 1st O.P.
Ex C3 – 25.04.2014: Repudiation letter by the 1st O.P.
Ex C4 – 13.05.2014: O/c of the regd notice.
Ex C5 - 02.06.2014: Postal Acknowledgment of 1st O.P.
Ex C6 – 26.05.2014: Reply of 2nd O.P.
Documents produced on behalf of the Complainant in CC:No.63/2015:
Ex C1 – 04.07.2014: Copy of the membership receipt.
Ex C2 – 28.07.2014: O/c of the claim sent to the 1st O.P.
Ex C3 – 25.08.2013: Repudiation letter by the 1st O.P. with 9 documents.
Ex C4 – 22.09.2014: O/c of the regd notice.
Ex C5 - 23.09.2014: Postal Acknowledgment of 1st O.P.
Ex C6 – 29.09.2014: Postal Acknowledgment of 2nd O.P.
Documents produced on behalf of the Complainant in CC:No.64/2015:
Ex C1 – 04.07.2014: Copy of the membership receipt.
Ex C2 – 28.07.2014: O/c of the claim sent to the 1st O.P.
Ex C3 – 25.08.2013: Repudiation letter by the 1st O.P. with 9 documents.
Ex C4 – 22.09.2014: O/c of the regd notice.
Ex C5 - 23.09.2014: Postal Acknowledgment of 1st O.P.
Ex C6 – 29.09.2014: Postal Acknowledgment of 2nd O.P.
Documents produced on behalf of the Complainant in CC:No.100/2015:
Ex C1 – 16.08.2014: Copy of the membership receipts (2).
Ex C2 – 15.09.2014: O/c of the claim sent to the 1st O.P.
Ex C3 – 27.10.2014: Repudiation letter with 17 documents.
Ex C4 – 03.11.2014: O/c of the regd notice.
Ex C5 - 14.11.2014: Postal Acknowledgment of 1st O.P.
Ex C6 – 12.11.2014: Postal Acknowledgment of 2nd O.P.
Documents produced on behalf of the Complainant in CC:No.112/2015:
Ex C1 – 05.10.2013: Copy of the membership receipt.
Ex C2 – 21.10.2013: O/c of the claim sent to the 1st O.P.
Ex C3 – 26.10.2013: Postal acknowledgment 1st O.P.
Ex C4 – 25.10.2013: Postal Acknowledgment 2nd O.P.
Ex C5 - 16.10.2013: Copy of the discharge summary.
Ex C6 – 16.10.2013: Copies of the bills (16).
Ex C7 – 11.10.2013: Abdomen and Pelvis Report.
Ex C8 – 23.01.2014: O/c of the regd notice.
Ex C9 – 31.01.2014: Postal acknowledgment of 1st O.P.
ExC10- 25.01.2014: Postal Acknowledgement of 2nd O.P.
Documents produced on behalf of the Complainant in CC:No.132/2015:
Ex C1 – 07.10.2013: Copy of the membership receipts (2).
Ex C2 – 01.03.2014: O/c of the claim sent to the 1st O.P.
Ex C3 – 22.03.2014: O/c of the regd notice.
Ex C4 - 29.03.2014: Reply of 2nd O.P.
Ex C5 – 13.03.2014: Letter addressed by 1st O.P. to district coordinator returning the claim papers with the annexures (29).
Documents produced on behalf of the Complainant in CC:No.180/2015:
Ex C1 – 25.08.2014: Copy of the membership receipt.
Ex C2 – 15.09.2014: O/c of the claim sent to the 1st O.P.
Ex C3 – 28.10.2014: Repudiation letter by the 1st O.P with 75 documents.
Ex C4 - 01.12.2014: O/c of the regd notice.
Ex C5 – 08.12.2014: Postal acknowledgment of 1st o.p.
Ex C6 – 06.12.2014: Postal acknowledgment of 2nd O.P.
Ex C7 – 20.12.2014: Copy of the death certificate.
Ex C8 – 17.11.2008: Copy of the Ration Card.
Witnesses examined on behalf of the Opposite Parties in C.C.Nos. 261,263,271,287,288,289,298,313,230,321,382,383,386,387,411,429,440 & 483 /2014 , 63/15, 64/15, 100/15, 112/15, 132/15, & 180/2015:
RW1 – Sri.R.M.Nataraj, Chief Executive Officer of O.P No.1.
RW2 – Sri.Sudharshan S.P.
Documents produced on behalf of the Opposite Party in CC:No. 261/2014, 271/2014, 287/2014,289/14, 313/14, 383/2014, 440/2014,
Ex C1 – Copy of the list of the operation and amount fixed for each operations.
Ex C2 – True copy of the Pamphlet given to the complainant.
Ex C3 – True copy of the letter written by the O.P. No. 1 to IRDA.
Ex C4 – True copy of the Endorsement issued by IRDA.
Ex C5 – True copy of the Protocol issued to the Hospital.
Documents produced on behalf of the Opposite Party in CC:No. 263/2014, 320/2014, 321/2014, 387/2014, 411/2014, 429/2014, 483/2014 and 63/2015, 64/2015, 100/2015, 112/2015, and 180/2015.
Ex C1 – True copy of the list of the network hospitals.
Ex C2 – True copy of the Pamphlet given to the complainant.
Ex C3 – True copy of the notice issued to Dhanvanthari Hospital.
Ex C4 – True copy of the letter written by the O.P. No. 1 to IRDA.
Ex C5 – True copy of the Endorsement issued by IRDA.
Documents produced on behalf of the Opposite Party in CC:No. 288/2014:
Ex C1 – True copy of the list of the network hospitals.
Ex C2 – True copy of the Pamphlet given to the complainant.
Ex C3 – True copy of the letter written by the O.P. No. 1 to IRDA.
Ex C4 – True copy of the Endorsement issued by IRDA.
Ex C5 – True copy of the acknowledgment for having served the terms and conditions, name of the network hospital and the list of operation to complainant.
Documents produced on behalf of the Opposite Party in CC:No. 298/2014, 382/2014, 386/2014, and 132/2015.
Ex C1 – True copy of the list of the network hospitals.
Ex C2 – True copy of the Pamphlet given to the complainant.
Ex C3 – True copy of the letter written by the O.P. No. 1 to IRDA.
Ex C4 – True copy of the Endorsement issued by IRDA.
Dated:29.01.2015 PRESIDENT
