Appeal No.

2528/2007
Filed on : 20.12.2007
Disposed on : 28.03.2008

BEFORE THE KARANATAKA STATE CONSUMER DISPUTES

REDRESSAL COMMISSION, BANGALORE.

DATED THIS THE 28/03/2008

PRESENT

THE HON’BLE MR. JUSTICE CHANDRASHEKARAIAH : PRESIDENT

SRI T. HARIYAPPA GOWDA : MEMBER
SMT. RAMA ANANTH : MEMBER

Appeal No.2528/2007

The Assistant Manager, Yashaswini Cell,

Yashaswini Co-operative Farmers Health Care Scheme,
FHPL, Agency No. 45, Miller’s Road
Vasanth Nagar,
Bangalore – 560 052
….OP Before the DF
….Appellant/s

-Versus-

1. C. D. Ganesh,
S/o Late Devaiah,
Kirundadu Village
Parane Post
Madikeri Taluk
Kodagu District
….Complainant before the DF
2. M/s Yashaswini Co-operative Farmers
Health Care Trust, Co-operative Department,
Government of Karnataka,
M. S. Building,
Bangalore – 1
Rep by its Chief Executive Officer.
…. OP Before the DF
….Respondent/s
(By Sri/ Smt R-I, in Person, R-II I. G. Gachinamath)
 ORDER

JUSTICE CHANDRASHEKHARAIAH, PRESIDENT:

This Appeal is by the OP challenging the order dated 22.11.2007 passed

by the DF, Kodagu in complaint No.45/2007 allowing the Complaint of
the Complainant.

The Complainant being a member of Yashaswini Scheme is entitled for

reimbursement of medical expenditure incurred by him. Accordingly the
complainant in a recognized hospital for taking necessary treatment got
admitted to A.J. Hospital Mangalore.

In the said hospital, they have conducted the surgery of ULTRA LOW
ANTERIOR RESECTION WITH END TO END ANASTOMISIS OF
TRANSVERSE COLON USING STAPLER on 1.6.2006. After the said
surgery, he had taken treatment for chemotherapy. Ultimately he has
spent a sum of Rs.90,402/- . Thereafter he made a claim for
reimbursement of the medical expenditure incurred by him.

Thereafter the trust constituted under the Yashaswini Scheme has paid
Rs.14,000/- spent for surgery and has not paid the amount spent by the
Complainant for chemotherapy treatment on the ground that the said
scheme does not provide for reimbursement for medical line treatment.
This has made the complainant to file the Complaint before the DF.

The DF considering the evidence adduced by both the parties has

allowed the Complaint with a direction to the OP to pay a sum of
Rs.76,402/- taking into account the amount of Rs.14,000/- as already
been paid and also awarded compensation of Rs.1,000/- and cost of
Rs.1,000/-. This order is under challenge by the OP in this Appeal.
The learned counsel appearing for the appellant submitted that
chemotherapy is a medical line treatment. If that is so, the scheme does
not provide for reimbursement of medical expenditure incurred by the
complainant for medical line treatment.

It is not in dispute that the complainant has undergone surgery in A.J.

Hospital Mangalore. Thereafter the Complainant was required to take
chemotherapy treatment in order to get cured from the disease.

The pamphlet issued by the OP at paragraph (14) provides that if a

treatment taken on medical line without the surgery no amount is
payable for reimbursement of the medical expenditure.

But in the instant case the complainant has undergone surgery and
thereafter has taken chemotherapy treatment as per the medical advice.
If that were to be the case, under the said clause it is not appropriate for
the OP to avoid its liability to reimburse the medical expenditure because
of the fact that the medical line treatment on account of the Surgery
which the Complainant has undergone. Therefore the DF is right in
allowing the complaint of the Complainant.

The learned counsel appearing for the appellant submits that the
amount if any is to be reimbursed it is by the trust and not by the
appellant. If that is so, it is open for the appellant/ OP to move the Trust
to reimburse the amount as directed by the DF. With this observation we
pass the following.
ORDER
Appeal is dismissed.

MEMBER. MEMBER. PRESIDENT