‘Doctors, not insurer decide treatment’

Surat: The Valsad District Consumer Redressal Commission (VDCRC) has directed United India Insurance Co Ltd to pay a claim amount of Rs 1.15 lakh to a woman from Silvassa in Dadra & Nagar Haveli, ruling that doctors advice for hospitalization is part of the patient’s treatment.

The insurance firm had in May 2019 rejected the claim of Dipali Vasaya on the grounds that her treatment for four-day at Mumbai-based Kokilaben Dhirubhai Ambani hospital did not require hospitalization.

Vasaya got chest pain and fell unconscious on September 14, 2018, and was taken to Kokila Dhirubhai Ambani Hospital in Mumbai. She was admitted on the advice of the doctor there and was discharged on September 18, 2018.

Her hospital treatment bill was Rs 1.15 lakh. As she had medical insurance of Rs 5 lakh from United India Insurance Co, she claimed reimbursement. However, the insurance firm rejected her claim in May 2019. “The procedure or treatment usually done in Out Patient Department are not payable under the policy even if converted as an in-patient in the hospital for more then 24 hours or carried out in Day Care Centre,” the firm contended.

Vasaya had approached Valsad District Consumer Redressal Commission in October 2019. VDCRC ruled, “The patient was hospitalised on the advice of the doctor and expenses incurred is related to medical treatment and the treatment was based on doctor’s advice and it is a part of the treatment and therefore complainant is entitled to get reimbursement claim amount with 7.5% interest effective from October 2019.”

It also ordered the insurance company to pay Rs 2,500 to the complainant for the mental stress and complaint fees.

Source: The Times of India