YESHASVINI CO Vs. L. ADISESHA AND ORS.

JUDGEMENT

(1.) Aggrieved by the order dated 5.3.2008 passed by the State Consumer Disputes Redressal Commission, Karnataka (herein after referred to as the State Commission), Bangalore in appeal Nos. 2086 and 2087 of 2007 directing the Deputy Manager as well the Chief Executive of Yeshasvini Co-operative Farmers Health Care Scheme (herein-after referred to as the Scheme), Bangalore to pay a sum of Rs. 1,11,055 to the complainant with interest @ 8% p.a. from the date of filing of the complaint before the District Forum till its realization, the Chief Executive Officer of the Scheme has filed this revision petition before us. Facts of the case in nutshell are that the complainant L. Adisesha and his family members were insured for their health care under the Scheme by paying the requisite insurance premium to the Primary Agriculture Co-operative Credit Bank Limited, Mudigundam Village. As the father of the complainant was suffering from blood pressure he got himself admitted for operation in BGS Apollo Hospital for surgery and was discharged from the hospital on 19.11.2005 and subsequently died at his house on 26.11.2005. At the time of discharge complainant delivered membership identity card No. CJR 1677099 but the hospital authorities refused to accept the same and collected the full bill amount without giving any concession. Accordingly, the complainant filed the complaint seeking reimbursement of Rs. 1,12,555. This was contested by the authorities of the scheme as they had not received pre-authorization from the hospital hence, they were not aware of the case. Further, the treatment extended to the patient was mainly for the medical management and intensive care support and as the pre-authorization, is a must to avail cashless benefit under the scheme; they had no liability to pay.

(2.) The Administrative Officer of the Apollo Hospital, Mysore had contended that father of the complainant was shifted from JSS hospital to their hospital in an unconscious condition, they had deposited Rs. 3,000 as an advance amount and the treatment meted out was mainly medical management and intensive care support.

(3.) After going through the records of the scheme and hearing the parties Counsel the District Forum directed the authorities of the Scheme to pay Rs. 1,11,055 to the complainant with interest @ 8% p.a. from the date of complaint till payment of entire amount.