VADODARA: Just because a Barodian consulted a neurologist during his treatment as indoor patient at a hospital, the state-run Oriental Insurance Company Ltd rejected on the grounds that his medical policy does not cover mental illnesses.

A consumer court here however turned down the insurance company’s claims and ordered it to pay Rs 30,439 treatment cost to the complainant Alpesh Mistry along with interest and Rs 3,000 as compensation.

Mistry, who works in a cement company, had suddenly suffered dizziness and headache in January 2015 for which he was admitted to a private hospital and was treated for five days. On admission, Mistry initiated process for cashless facility.

However, the insurance company turned down his claim application saying that his policy does not cover psychosomatic disorders. Psychosomatic disorder is a condition in which psychological stresses adversely affect physiological functioning to the point of distress.

As he was diagnosed for frontal lobe syndrome and not psychosomatic disorder Mistry again submitted his documents and claim applications which was also rejected. Mistry then approached the Vadodara district Consumer Disputes Redressal Forum. During the hearing, the insurance company’s lawyer opposed the case presented by Mistry and reiterated that he was treated for psychosomatic disorder which is not covered under the policy.

Mistry’s lawyer submitted medical documents and certificates confirming his claims that his headache and dizziness was an acute condition and not a mental illness as presented by the insurance company.

The court upheld the Mistry’s documents and arguments and pointed out that the insurance company did not submit any evidence supporting their arguments and presented a wrong reason for rejecting Mistry’s claim.

Source: The Times of India