A.K.ANNAMALAI, J. - (1.) 1st opposite party is the appellant.
(2.) Complainant enrolled with the Government Medical Insurance Scheme as a Government employee working as P.G.Teacher by payment of Rs.25/- per month as prescription for the medical scheme covering himself and for his family members. On 18.12.09 due to urgent treatment for her daughter Gayathri got admitted in the 2nd opposite party?s hospital and undergone eye surgery on 19.12.09 and was discharged on 23.12.09 for which the complainant had spent Rs.52,698/- and when he claimed the same from the 1st opposite party under the insurance coverage which was repudiated on the ground that the treatment was taken without prior intimation and thereby he was compelled to pay the amount to the 2nd opposite party to get discharge of his daughter and thereby he had suffered mental agony and ordeal in this regard and thereby filed consumer complaint claiming Rs.3,00,000/- as compensation and Rs.52,698/- towards the reimbursement of the medical expenses from the opposite parties.
(3.) Opposite parties denied the allegations of the complainant and the 1st opposite party contended under scheme of Medical Insurance to the Government servant, the treatment could be taken only in the notified hospitals and with prior intimation to the coordinator of the company. The treatment taken by the complainant?s daughter ORBITATOMY ABND EVACUATION is not covered under the scheme and the scheme also not covered for reimbursement of the money and the scheme is for cashless basis. Hence the 1st opposite party is not liable to reimburse any money or for payment of any compensation. Further as per G.O Ms No.174 dated 17.4.08 the Consumer Forum has no jurisdiction to entertain the claim.;