Rebecca.Samervel

Mumbai:

Observing that consumers should not suffer due to rigid, unreasonable and absurd clauses in insurance policies, a district forum has ruled in favour of a woman after her reimbursement claim towards sequential programmed magnetic field (SPMF), a nonevasive osteoarthritis treatment, was rejected by the insurance company on the grounds that it was not done under hospitalization.

“Considering the benefits of advanced technologies, various insurance companies are required to think of the interests of its consumers while drafting the terms and conditions of insurance policies instead of focusing on rejecting genuine claims on rigid and flimsy grounds,” the forum said.

The forum directed ICICI Lombard General Insurance to pay the complainant, Sushila Arya, Rs 1.31 lakh towards reimbursement and around Rs 62,000 as compensation.

At present, there are some insurance companies that cover alternative therapies, but these are usually restricted to Ayush (Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy)—an umbrella of non-allopathy treatments recognized by the Indian government.

The forum said that insured persons should not be made to suffer especially when advance technology and specialized infrastructural facilities made available at various hospitals help improve the patient’s quality of life, saves time and eliminates unnecessary hospitalization. “The insurance company has wrongly repudiated the genuine claim of the complainant on absurd and rigid and unreasonable ground due to which she must have gone through mental agony,” the forum said.

The insurance company told the forum that Arya’s claim was rejected as her treatment didn’t require hospitalization. But the forum pointed out that exclusion policy regarding time limit was not applicable on treatments like dialysis, chemotherapy, radio therapy and eye surgery, in which patients were discharged the same day.

The forum said the complainant submitted that the treatment was painless, cheaper and scientifically proven. It said that the insurance company had not produced information contrary to the submissions made by the complainant about the benefits of the treatment.