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VADODARA: A person can claim insurance even if he or she was not admitted to the hospital for ‘at least’ 24 hours, observed a Vadodara consumer forum while ordering an insurance firm to pay money to Rameshchandra Joshi, a resident of Gotri Road in the city.
The Vadodara Consumer Disputes Redressal Commission (additional) also observed that with the advent of new technology, patients sometimes are treated in lesser time or without being hospitalised.
Joshi had filed a complaint against National Insurance Company Ltd in August 2017 after the firm rejected his claim. The complainant’s wife had suffered from dermatomyositis in 2016 and was admitted to Lifecare Institute of Medical Science and Research Centre in Ahmedabad. She was discharged the next day after treatment.
Joshi filed for an insurance claim of Rs 44,468 but the insurance firm rejected it by citing clause 3.15 and arguing that she wasn’t admitted continuously for 24 hours as per the policy’s clause. He presented all the documents in the consumer forum and stated that his wife was admitted at 5.38 pm on November 24, 2016 and discharged at 6.30 pm on November 25, 2016 which was more than 24 hours.
The forum observed that even if it is assumed that the patient was admitted for less than 24 hours in the hospital, in the modern age new treatments and medicines have been developed and the doctor gives treatment as per that.
“In the earlier era, people had to be admitted for a longer time for treatment but with the advent of new technologies patients can be treated without getting admitted in the hospital or in less time after getting admitted,” the forum observed.
“If the patient isn’t admitted to the hospital or is treated in less time after being admitted due to new techniques, the insurance firm can’t reject the claim by saying that the patient wasn’t admitted to the hospital,” the forum added.
The forum also observed that an insurance firm can’t decide if it is required for the patient to be admitted to the hospital and only doctors can make decisions based on new technology, medicines and the condition of the patient. The forum ordered the insurance firm to pay Rs 44,468 to Joshi with 9% interest from the date when the claim was rejected.
The insurer was also ordered to pay Rs 3,000 for mental harassment and Rs 2,000 towards litigation costs to Joshi.
The Vadodara Consumer Disputes Redressal Commission (additional) also observed that with the advent of new technology, patients sometimes are treated in lesser time or without being hospitalised.
Joshi had filed a complaint against National Insurance Company Ltd in August 2017 after the firm rejected his claim. The complainant’s wife had suffered from dermatomyositis in 2016 and was admitted to Lifecare Institute of Medical Science and Research Centre in Ahmedabad. She was discharged the next day after treatment.
Joshi filed for an insurance claim of Rs 44,468 but the insurance firm rejected it by citing clause 3.15 and arguing that she wasn’t admitted continuously for 24 hours as per the policy’s clause. He presented all the documents in the consumer forum and stated that his wife was admitted at 5.38 pm on November 24, 2016 and discharged at 6.30 pm on November 25, 2016 which was more than 24 hours.
The forum observed that even if it is assumed that the patient was admitted for less than 24 hours in the hospital, in the modern age new treatments and medicines have been developed and the doctor gives treatment as per that.
“In the earlier era, people had to be admitted for a longer time for treatment but with the advent of new technologies patients can be treated without getting admitted in the hospital or in less time after getting admitted,” the forum observed.
“If the patient isn’t admitted to the hospital or is treated in less time after being admitted due to new techniques, the insurance firm can’t reject the claim by saying that the patient wasn’t admitted to the hospital,” the forum added.
The forum also observed that an insurance firm can’t decide if it is required for the patient to be admitted to the hospital and only doctors can make decisions based on new technology, medicines and the condition of the patient. The forum ordered the insurance firm to pay Rs 44,468 to Joshi with 9% interest from the date when the claim was rejected.
The insurer was also ordered to pay Rs 3,000 for mental harassment and Rs 2,000 towards litigation costs to Joshi.
