New Delhi: Vadodara Consumer Forum has given a big order on Medical Insurance claims. The forum said that a person can claim medical insurance even if he is not admitted to the hospital or is admitted for less than 24 hours. The forum said that due to the advent of new technology, now sometimes patients are treated in less time or even without hospitalization. Therefore, the insurance company cannot reject the claim by saying that the person was not admitted to the hospital for 24 hours. The Vadodara Consumer Forum ordered the insured to pay the claim amount as well as compensation for litigation expenses and mental agony.
This order was given on the petition of Vadodara resident Ramesh Chandra Joshi. Joshi filed a complaint against National Insurance Company Limited in 2017. His allegation was that the company had rejected his claim on the basis of not staying in the hospital for 24 hours. Joshi’s wife was diagnosed with dermatomyositis in 2016 and was admitted to the Lifecare Institute of Medical Science and Research Center in Ahmedabad.
Was given leave in 1 day
Joshi’s wife was kept in the hospital for treatment only for one day. The hospital discharged him the next day. Rameshchandra Joshi filed a claim to get Rs 44 thousand 468. But the insurance company rejected it citing clause 3.15 of the policy and argued that he was not admitted continuously for 24 hours as per the clause in the policy. Joshi filed a case against the company in the Vadodara Consumer Forum. He told that his wife was admitted on November 24, 2016, at 5.38 pm and was discharged on November 25, 2016 at 6.30 pm, which was more than 24 hours.
Not necessarily admitted
The Forum, while giving its verdict in favor of Joshi, said that due to the advent of modern technology, treatment can be given to the patient in less than 24 hours. Earlier people used to be hospitalized for a long time for treatment. Now with new techniques, it is possible to treat patients without admission or in less time.
Therefore, if the patient is not admitted to the hospital for treatment, or is admitted for a short period of time, then the insurance company cannot reject the claim by saying that the patient was not admitted to the hospital. The insurance company cannot decide whether hospitalization of the patient is necessary or not.
The doctor can decide whether the patient will be treated in the hospital or at home. The forum ordered the insurance company to pay Rs 44,468 to Joshi along with 9% interest from the date of rejection of the claim. Also ordered to pay Rs 2,000 for litigation expenses and Rs 3,000 for mental harassment.
