BEFORE THE DAKSHINA KANNADA DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, MANGALORE
Dated this the 31st day of May, 2016
PRESENT
SMT. ASHA SHETTY : HON’BLE PRESIDENT
SMT.LAVANYA M. RAI : HON’BLE MEMBER
COMMON ORDER IN
C.C.Nos. 89, 97, 101, 102, 147, 166, 215, 225/2015
CC.No.89/2015
(Admitted on 28.02.2015)
Kairunnisa,
W/o Abdul Razzak,
Aged about 24 years,
R/at Perlampady,
Neeladka,
Sullia Tq. And D.K. 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. Manager,
Kalmadka Vyavasaya Seva Sahakari,
Bank, Niyamitha Kalmadka,
Sullia Tq. And D.K. Dist. …. OPPOSITE PARTIES
(Advocate for Opposite Party No.1: Sri Thimmayya P.)
(Advocate for Opposite Party No.2 : Krishna Prasad M.S.,)
CC.No.97/2015
(Admitted on 28.02.2015)
Ramesh
S/o Lingappa Gowda,
Aged about 28 years,
R/at Badi House,
Patrame Post and Village,
Belthangady Tq. and D.K. Dist.
…… 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 Pvt. Ltd.,
No.41, 16th Main, 2nd Cross,
2nd Stage, 1st Phase, BTN Layout,
Bangalore – 560076.
3. Chief Executive Officer,
Kokkada Seva Sahakari Sangha N.,
Kokkada, Belthangady Tq.
D.K. Dist.-574198.
……. OPPOSITE PARTIES
(Advocate for Opposite Party No.1: Sri Thimmayya P.)
(Opposite Party No.2 & 3: Exparte)
CC.No.101/2015
(Admitted on 13.03.2015)
Smt.Raziya Banu,
W/o Abubakker Siddique,
Aged about 25 years, R/at Kabaka House, Kula Village,
Bantwal Taluk, D.K. Dist. …… 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. C.E.O.,
Idkidu Seva Sahakari Sangha N.,
Idkidu Post,
Bantwal Taluk,
D.K. District.
3. Medical Officer,
Chethana Hospital,
Near Shri Mahammaya Temple,
Puttur, D.K.Dist. ……. OPPOSITE PARTIES
(Advocate for Opposite Party No.1: Sri Thimmayya P.)
(Advocate for Opposite Party No.2 : Sri Rajesh K.G.)
(Opposite Party No.3 : Exparte)
CC.No.102/2015
(Admitted on 13.03.2015)
Mahammed Sahshuddeen,
S/o Moose Kunhi,
Aged about 27 years,
R/at Kabaka House,
Kula Village,
Bantwal Taluk and D.K. Dist. …… 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. C.E.O.,
Idkidu Seva Sahakari Sangha N.,
Idkidu Post, Bantwal Taluk, D.K. Dist.
4. Medical Officer,
Athena Hospital, Falnir Road,
Mangalore – 01 D.K. ……. OPPOSITE PARTIES
(Advocate for Opposite Party No.1 Sri Thimmayya P.)
(Opposite Party No.3 : Rakesh K.G)
Opposite Party No.2 and 4: Exparte)
CC.No.147/2015
(Admitted on 28.04.2015)
Smt.Rajashree M.Shetty,
W/o Muralidhara K.Shetty,
Aged about 47 years,
R/at Kallaje House,
Kedila Post and Village,
Bantwal Tq. and D.K. District. …… 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. C.E.O.,
Kedila Seva Sahakari Sangha N.,
Kedila Post,
Bantwal Taluk – 574221. ……. OPPOSITE PARTIES
(Advocate for Opposite Party No.1 : Sri Thimmayya P.)
(Advocate for Opposite Party No.2 : Sri J.Narayana Prasad)
CC.No.166/2015
(Admitted on 02.06.2015)
Purushothama Dambekodi,
S/o Late Puttanna Gowda,
Aged about 41 years,
R/at Keblady House,
Ivathoklu Post,
Sullia Tq., D.K. Dist. …… 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. C.E.O.,
Panja Sahakari Vyavasayika Bank N.,
Panja,
Sullia Tq. D.K. Dist. …. OPPOSITE PARTIES
(Advocate for Opposite Party No.1 : Sri Thimmayya P.)
(Opposite Party No.2 : Exparte)
CC.No.215/2015
(Admitted on 17.07.2015)
Mahammed K.,
S/o Abdulla,
R/at Kuthyala, Sasihithlu House,
Ishwaramangala Post, Puttur Taluk,
D.K. Dist. …… 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,
Ishwaramangala Milk Producers
Sahakari Sangha N.,
Kedila Post,
Bantwal Taluk - 574221. ……. OPPOSITE PARTIES
(Advocate for Opposite Party No.1 : Sri Thimmayya P.)
(Advocate for Opposite Party No.2 : Exparte)
CC.No.225/2015
(Admitted on 17.07.2015)
K.Shivarama Upadyaya,
S/o K.Krishna Upadyaya, Aged about 53 years,
R/at Pariyala House, Punacha Post & Village,
Bantwal Tq. D.K. District. …… 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
Punacha Milk Producers Sahakari,
Vyavasaya Sangha N. No.10242, Bantwal,
D.K. District – 574281 …. OPPOSITE PARTIES
(Advocate for Opposite Party No.1: Sri Thimmayya P.)
(Opposite party No. 2 Ex-parte)
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. 89, 97, 101, 102, 147, 166, 215, 225/2015 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.89/2015 claimed that she had taken treatment in Chethana Hospital, Puttur for Emergent Laparoscopic Surgery and admitted as an inpatient on 17.05.2011 and undergone operation, discharged on 21.05.2011 and spent Rs.15,500/-, 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. 97/2015 claimed that his father had taken treatment in City Hospital Research and Diagnostic Centre, Kadri, Mangalore for Chronic Calcific Pancreatitis and Laprotomy Head Section and admitted as an inpatient on 09.07.2012 and undergone operation, discharged on 26.07.2016. Once again the complainant’s father was admitted as an inpatient in the same hospital on 30.07.2012 for Cholangitis with blocked CBD stent and was discharged on 04.08.2012 and thereafter again admitted in the same hospital on 03.09.2012 for Acute Severe Cholangitis with Cholecystitis and after operation discharged on 13.09.2012 and spent Rs.2,31,157/-, 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. 101/2015 claimed that she had taken treatment in Chetana Hospital, Puttur for Delivery and admitted as an inpatient on 10.01.2014 and undergone operation, discharged on 12.01.2014 and spent Rs.6,645/-, 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. 102/2015 claimed that he had taken treatment in Athena Hospital, Falnir Road, Mangalore for Ulcerative Colitis and admitted as an inpatient on 21.10.2013 and undergone operation, discharged on 24.10.2013 and spent Rs.16,385/-, 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. 147/2015 claimed that she had taken treatment in A.J. Hospital Mangalore for Fibroid Uterus and admitted as an inpatient on 07.10.2013 and undergone operation, discharged on 14.10.2013 and spent Rs.55,738/-, 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.166/2015 claimed that his wife had taken treatment in Dhanvanthari Hospital Puttur for Caesarian Operation and admitted as an inpatient on 01.02.2013 and undergone operation, discharged on 07.02.2013 and spent Rs.18,510/-, 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. 215/2015 claimed that he had taken treatment in Dhanvanthari Hospital, Puttur for Peyronics Disease and admitted as an inpatient on 24.12.2013 and undergone operation, discharged on 27.12.2013 and spent Rs.17,600/-, 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.225/2015 claimed that his minor son Ravikiran Upadyaya had taken treatment in Dhanvanthari Hospital, Puttur Dharmasthala for Laparoscopic Appendisectomy and admitted as an inpatient on 07.08.2014 and undergone operation, discharged on 11.08.2014 and spent Rs.24,520/-, but the Opposite Party did 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 Co-op. Farmers Health Care Scheme, but the Opposite Parties did not reimbursed medical expenses spent by them till this date. Further the 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 Co-operative Farmers Health Care Scheme, Bangalore filed similar version in all the complaints wherein stated that Yashaswini Co-operative Farmer Health Care Scheme is not an 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. 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 complaints.
In CC.No.97, 102, 166, 215, 225/2015 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.
In CC.No.97, 101/2015 the Opposite Party No.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.3.
In CC.No.102/2015 the Opposite Party No.4 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.4.
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 proved 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 beneficiaries 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 Co-operative 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.
The Honble State Commission observed that 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 .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 16 dictated to the Stenographer typed by him, revised and pronounced in the open court on this the 31st day of May, 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: Kairunnisa – Complainant in CC.No.89/2015.
CW1: Ramesh – Complainant in CC.No.97/2015.
CW1: Raziya Banu– Complainant in CC.No.101/2015.
CW1: Mohammed Shashudeen – Complainant in CC.No.102/2015.
CW1: Rajashree M.Shetty – Complainant in CC.No.147/2015.
CW1: Purushothama Dambekodi – Complainant in CC.No.166/2015.
CW1: Mahammed K.– Complainant in CC.No.215/2015.
CW1: Shivarama Upadyaya – Complainant in CC.No.225/2015.
Documents produced on behalf of the Complainant in CC:No.89/2015:
Ex C1 – Copy of the membership receipt dated 10.05.2011.
Ex C2 – Copy of the discharge summary dated 21.05.2011.
Ex C3 – Copies of the bills dated 21.05.2011.
Ex C4 – O/C of the regd. Lawyer’s notice dated 13.11.2012.
Ex C5 – Postal Acknowledgement of 2nd Opposite Party dated 15.11.2012
Ex C6 – Reply of the 1st Opposite Party.dated 05.12.2012.
Documents produced on behalf of the Complainant in CC:No.97/2015:
Ex C1 – Copies of the membership receipts (2)
Ex C2 – O/c of the claim dated 13.12.2012.
Ex C3 – Postal Acknowledgement dated 04.04.2013.
Ex C4 – Copy of the discharge summary dated 26.07.2012.
Ex C5 – Copies of the bills (34)
Ex C6 – Copy of the discharge summary dated 01.08.2012.
Ex C7 – Copies of the bills (38)
Ex C8 – Copy of the discharge summary dated 13.09.2012.
Ex C9 – Copies of the bills (22)
Ex C10–Copy of the discharge summary dated 05.10.2012
Ex C11–Copies of the bills (14)
Ex C12–Copy of the email sent by Co-Ordinator to the 2nd OP.
Ex C13–O/c of regd. Lawyer’s notice.
Ex C14–Postal Acknowledgement
Ex C15–Postal Acknowledgement
Ex C16–Reply of 3rd Opposite Party.
Ex C17–Copy of the Death Certificate of Lingappa Gowda.
Documents produced on behalf of the Complainant in CC:No.101/2015:
Ex C1 – Copy of the membership receipt dated 24.08.2013.
Ex C2 – Self declaration form issued by 2nd OP dated 11.01.2014.
Ex C3 – Copy of the summary sheet dated 10.01.2014.
Ex C4 – Copy of the bills (3)
Ex C5 – O/c of the regd. Lawyer’s notice dated 11.06.2014.
Ex C6 – Postal Acknowledgement of the 1st OP dated 20.06.2014.
Ex C7 – Postal Acknowledgement of the 2nd OP dated 19.06.2014 .
Ex C8 – Reply of 3rd Opposite Party.
Documents produced on behalf of the Complainant in CC:No.102/2015:
Ex C1 –Copy of the membership receipt dated 24.08.2013.
Ex C2 – Original Discharge Summary dated 24.10.2013.
Ex C3 – Copies of the bills (2)
Ex C4 – O/c of the regd. Lawyer’s notice dated 27.06.2014.
Ex C5 – Postal Acknowledgement of 1st, 2nd, and 3rd OP dated 30.06.2014.
Ex C6 – Postal Acknowledgement of 4th OP dated 28.06.2014.
Documents produced on behalf of the Complainant in CC:No.147/2015:
Ex C1 – Copy of the membership receipts dated 20.09.2013.
Ex C2 – O/c of the claim sent to the 1st OP dated 30.10.2013.
Ex C3 – Postal acknowledgement of 1st OP dated 05.11.2013.
Ex C4 – Copy of the discharge summary dated 14.10.2013.
Ex C5 – Copies of the bills (11)
Ex C6 – O/c of regd. Lawyer’s notice dated 03.07.2014.
Ex C7 – Postal Acknowledgement of 1st OP dated 08.07.2013.
Ex C8 – Postal Acknowledgement of 2nd OP dated 04.07.2013..
Documents produced on behalf of the Complainant in CC:No.166/2015:
Ex C1 – Copy of the membership receipt dated 10.04.2012.
Ex C2 – O/c of the claim sent to the 1st OP dated 07.02.2013.
Ex C3 – Letter of repudiation by the 1st Opposite Party for returning the
claim papers with annexures (13)
Ex C4 – O/c of the regd. Lawyer’s notice dated 08.03.2013.
Ex C5 – Reply of the 1st Opposite Party dated 16.04.2013.
Ex C6 – Postal Acknowledgement of 2nd OP dated 09.03.2013.
Documents produced on behalf of the Complainant in CC:No.215/2015:
Ex C1 – Copy of the membership receipts dated 24.08.2013
Ex C2 – O/c of the claim sent to the 1st OP dated 13.01.2014.
Ex C3 – Repudiation letter by the 1st OP with 10 documents.
Ex C4 – O/c of regd. Lawyer’s notice dated 10.02.2014.
Ex C5 – Postal Acknowledgement of 1st OP dated 17.02.2014.
Ex C6 – Postal Acknowledgement of 2nd OP dated 15.02.2014.
Documents produced on behalf of the Complainant in CC:No.225/2015:
Ex C1 – Copy of the membership receipts dated 31.07.2014.
Ex C2 – O/c of the claim sent to the 1st OP dated 01.09.2014.
Ex C3 – Repudiation letter by the 1st OP with 15 documents.
Ex C4 – O/c of regd. Lawyer’s notice dated 20.11.2014
Ex C5 – Postal Acknowledgement of 1st OP dated 24.11.2014.
Ex C6 – Postal Acknowledgement of 2nd OP dated 22.11.2014
Documents produced on behalf of the Opposite Parties in CC:No. 89/2015, 101/2015 , 102/2015, 147/2015
Ex R1 – True copy of the list of the network hospitals.
Ex R2 – True copy of the Pamphlet given to the complainant.
Ex R3 – True copy of the letter written by the O.P. No. 1 to IRDA.
Ex R4 – True copy of the Endorsement issued by IRDA.
Documents produced on behalf of the Opposite Parties in CC:No. 97/2015
Ex R1 – Copy of the list of the operation and amount fixed for each
operation.
Ex R2 – True copy of the Pamphlet given to the complainant.
Ex R3 – True copy of the letter written by the O.P. No. 1 to IRDA.
Ex R4 – True copy of the Endorsement issued by IRDA.
Documents produced on behalf of the Opposite Parties in CC:No. 166/2015, 215/2015, 225/2015
Ex R1 – True copy of the list of the network hospitals.
Ex R2 – True copy of the Pamphlet given to the complainant.
Ex R3 – True copy of the Notice issued to Dhanvanthari Hospital.
Ex R4 – True copy of the letter written by the OP No.1 to IRDA.
Ex R5 – True copy of the Endorsement issued by IRDA.
Dated:31.05.2015 PRESIDENT
