Denial of Cashless Treatment by the Opposite parties

S

Swamy A.N.

New member
Policy Name
Family Medicare Policy
Company Name
M/s United Indian Insurance Co. Ltd. M/s Soorya Hospital,
Customer Care Number
040 23244264
Loss Amount
57675.00
Ratings
4.00 star(s)
Opposite Party Address
United India Insurance Company Limited
Direct Agents Branch, Vth floor,
3-5-817 & 818, United India Towers,
Basheerbagh, Hyderabad
Telangana – 500029
and
M/s Soorya Hospitals
Plot no. B-4/B/1, E.C., Kushaiguda,
ECIL "X" Roads, Hyderabad - 500062
Through its Proprietor, Dr. Jagadeesh Babu
Cell No. 9290284858 & 6390256789
E-mail: sooryahospitalsecil@gmail.com
Complainant: Allada Narayana Swamy, aged 63 years, S/o late Allada Veera Raghavulu

Policy No.: 0515042824P115990423 with United India Insurance Company Limited (valid until 18.01.2026).

Coverage: Cashless treatment up to Rs. 2,00,000/-

BRIEF FACTS​

  1. Accident & Treatment: On 19.04.2025, I met with a road accident, causing dislocation/fracture of the right hand, injury above the right eyebrow, and multiple bruises. I was admitted to Soorya Hospital for emergency treatment, including shoulder setting, disc fixing with plate/screw, and eye suturing.
  2. Billing Issues:
Initial quotation: Rs. 68,000/- (approved by insurance)
Final bill: Rs. 1,75,399/-
Insurance authorized: Rs. 1,17,224/- only
Deduction: Rs. 58,175/-

Wrongful Detention: Despite medical clearance on 21.04.2025 afternoon and insurance settlement at 17:00 hours, the hospital detained me until 22:00 hours, demanding Rs. 42,000/- (the unauthorized amount).

  1. Harassment: Hospital staff threatened my wife with police action when she questioned the additional charges, causing mental agony and violating women's dignity.
  2. Financial Loss: Despite the cashless policy, forced to pay Rs. 57,675/- total (Rs. 42,000/- + Rs. 15,675/- related expenses).

DEFICIENCY IN SERVICE & UNFAIR TRADE PRACTICES​

Against Soorya Hospital:
  • Failed to provide transparency regarding quotation and final bill breakdown
  • Violated insurance authorization terms by forcibly collecting an unauthorized amount despite clear instructions that "amount deducted by Insurance Company shall not be collected from member"
  • Wrongful detention and harassment
Against United India Insurance:
  • Failed to share approval letters and deduction details with the policyholder
  • Failed to monitor hospital compliance with authorization conditions
  • Deficient implementation of the cashless facility

VIOLATIONS​

Deficiency in service under Section 2(11), Consumer Protection Act 2019
Unfair trade practice under Section 2(47), Consumer Protection Act 2019
Violation of Constitutional rights (Articles 15 & 21)
Wrongful restraint and harassment of women
Breach of contract and trust

PRAYER​

A. MAIN RELIEF:
  1. Refund Rs. 57, 675/- wrongfully collected with 18% interest p.a.
  2. Rs. 5,00,000/- compensation each from both parties for mental agony, harassment, and violation of women's rights
  3. Direct the insurance company to ensure proper cashless facility monitoring
B. CONSEQUENTIAL RELIEF:
  1. Rs. 50,000/- punitive damages each from both parties
  2. Gender-sensitization training for hospital staff
  3. Rs. 15,000/- towards complaint cost
  4. Public apology from the hospital for the dignity violation
C. INTERIM/ALTERNATIVE RELIEF: Grant interim relief as necessary and/or refer to the State Women's Commission for women's rights violations.

Total Claim Amount: Rs. 11,72,675/- plus interest and costs

Documents: Medical records, insurance policy, authorization letter (Part-D), payment receipts, and related evidence will be submitted separately.
 

Attachments

Back
Top