M.THANIKACHALAM J. - (1.) The third opposite party in OP.136/2005, on the file of the District Consumer Disputes Redressal Forum, Chennai [North] is the appellant, since they have received an adverse order, as per the pronouncement dated 07.07.2008.
(2.) The complainant, who is a senior citizen, had taken a Medical Insurance Health Card bearing No.HE121069573B from the third opposite party/appellant for the period from 09.03.2004 to 08.03.2005, enabling him to take treatment in the Network of third opposite partys hospital and the first opposite party is one of the Hospital. The complainant had some problem in anus, due to some growth, for which, as advised by the family doctor, he had taken treatment in the first opposite partys hospital. On the basis of the Health Card, the first opposite party has not asked, to pay any amount and he was admitted in the hospital on 11.09.2004 where a surgery was performed on 13.09.2004, for which, they have charged a sum of Rs.32,034/-. The request of the complainant for reimbursement, based upon the policy called Cashless Policy ended in vain, resulting not only over stay in the hospital, but also, causing mental agony. By the negligent and deficiency acts committed by the opposite party, the complainant was put to mental agony, for which, he is entitled to a sum of Rs.50,000/-, in addition to the medical expenses, incurred along with cost. Thus, a consumer complaint was presented, before the District Forum.
(3.) The first opposite party admitting the treatment given to the complainant, based upon Health Card, without insisting the payment, opposed the complaint, inter alia, contending that when the second opposite party informed that they are unable to approve the cashless request of the complainant based upon the opinion of their doctors, they have compelled to collect the fees, which cannot be termed as deficiency in service, thereby prayed for the dismissal of the complaint.;