Mr. C. D. Ganesh of Parane, Kodagu had Carcinoma of Rectum. He had undergone Ultra-low Anterior Resection of Rectum at A. J. Hospital Mangalore. After the surgery he was advised Chemotherapy as part of the surgery. He spent Rs. 90,402/- in all towards his surgical treatment. He had Yashaswini. FHPL, the Opposite Party in this case, who is the implementing agency recommended only Rs.14,000/-. It did not recommend to cover the cost of whole surgery and its treatment. C.D. Ganesh complained to Kodagu Consumer Court at Madikeri (Karnataka). FHPL pleaded that it is only the implementing agency and not responsible for the rules framed by Yashaswini. Court held that duty is cast on FHPL to protect the interest of the Farmer member, so if any order is passed the implementing agency shall see to it that the order is conveyed and communicated to its Principal, Yashaswini Trust and arrange for the necessary settlement to the poor farmer. FHPL argued that Chemotherapy is not part of surgery and not covered. Court disagreed and asked as to what was the use of surgery without giving chemotherapy in a case of Carcinoma of Rectum which cannot be cured by surgery alone and held that chemotherapy is a necessary adjunct for completion of treatment and also expressed the view that chemotherapy is not ‘medical’ treatment which is under exclusion but part and parcel of surgical treatment which is obviously covered. The court expressed the view that Chemotherapy cannot be said to be under exclusion just because it (chemotherapy) does not figure among the 1,600 surgeries list to which its attention was drawn. It said that when the Networked Hospital has prepared a bill for Rs.90,402/= towards the treatment of a condition that was listed, sanctioning a meager sum of Rs.14,000/= and resorting to say that it is the package is useless, neither here nor there, and said that such limitations cannot be put and totally unjustified. On account of the above, it ordered FHPL to pay the balance amount of Rs.76,402/= to the complainant along with Rs.1000/- towards mental agony and Rs.1000/- towards court expenses.

For details open the attached file which contains the text of full judgment.