The Virudhunagar District Consumer Disputes Redressal Commission has ruled in favor of R. Nagendran, a patient who was denied cashless treatment under the Tamil Nadu Government Employee New Health Insurance Scheme at a private hospital in Madurai. The hospital has been instructed to compensate Nagendran with Rs 1 lakh and return the Rs 1 lakh collected from him for treatment. Additionally, both the hospital and the insurance company have been directed to pay Rs 10,000 each towards legal expenses.
Nagendran, whose wife is a government employee, was admitted to the hospital in January 2023 for heart treatment. Despite being eligible for cashless treatment, he was asked to pay Rs 1.83 lakh upfront. Although the insurance company sanctioned Rs 1.38 lakh for treatment through two authorisation letters, the hospital did not refund the remaining Rs 54,400, claiming non-payment by the insurance company.
The commission's presiding officer, S.J. Chakravarthi, and member M. Muthulakshmi, in their ruling dated 17 May, have ordered the insurance company to pay Rs 1.83 lakh to the hospital within six weeks. Simultaneously, the hospital is mandated to refund Rs 1 lakh to Nagendran within the same period.
