Mr. Madhukar Rao I., a member of Ivarnad Society at Sullia had Yashaswini Insurance. He resides at Mangalore. He underwent Hernia surgery with Prostate Surgery at Yenepoya Specialty Hospital, Kodialbail, Mangalore. Yenpoya Hospital was one of the network hospitals. They sent for pre-authorization. Yashaswini sanctioned only Rs.12,000/-. Total Bill came to Rs.62,452/-. The difference amount went unpaid by Yashaswini. Yashaswini had undertaken the responsibility of getting its members treatment without having to pay anything for it; it had undertaken to tackle the hospital in case the network hospital charged more than what was allowed by Yashaswini. But in this case Yashaswini failed to make the hospital extend the treatment as per the MOU. When it was brought to the notice of Yashaswini, instead of taking up the matter with Yenepoya Hospital authorities, Yashaswini snubbed its member who was weak anyway saying that that was all Yashaswini would pay and if any extra amount is charged and collected by the Hospital, it was in no way responsible. Irked by the attitude of Yashaswini, Madhukar Rao Sued Yashashwini for the entire amount in the District Consumer Forum Mangalore. President Mrs. Asha Shetty up held his argument and allowed the complaint. The forum ordered Yashaswini to pay the difference amount of Rs. 52,452/- along with Rs.2,000/- Cost and interest at 9% p.a. from the date of the Complaint till the date of payment.

Please go through the entire text of Judgment here :

Madhukar Rao I DK Dist Forum Judgment.zip


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