Consumer Court Asks Insurance Firm to Compensate Medical Claim

No patient wants to unnecessarily stay in hospital for even an hour, a consumer court has said directing an insurance firm to compensate a man who was denied medical claim for her daughter's injuries on the ground that her wounds were not serious enough to require hospitalization.

Terming the repudiation of mediclaim as"malafide and deficiency in service", the Forum directed the state-owned National Insurance Company Ltd to pay Rs 17,270 to Ashok Narain Sharma, a resident of Model Town in north Delhi. The panel said patients cannot assume the role of doctor and they cannot defy the advice of their consultants.

“When the doctor suggests a stay as indoor patient, the patient has to follow the directives of the doctor. No patient will like to remain admitted even for an hour," Central district Consumer Forum President A K Jain said.

Kirti Sharma, daughter of the complainant, who had met with an accident remained admitted to a private hospital for four days in August, 2006. The complainant, who approached the insurance company for reimbursement of Rs 12,270 for expenses incurred her treatment, was shocked to know that his claim had been rejected on the ground that her injuries did not require hospitalisation.

The company, relying upon a report of a surveyor, had submitted that the insured patient had minor injury on her face in which OPD treatment was enough.