Thursday Oct 19, 2023
Kochi> The Ernakulam District Consumer Disputes Redressal Commission said that in the era of modern technology and robotic surgery in the field of medicine, the requirement of 24-hour hospital stay by insurance companies to get health insurance is a violation of consumer rights. Ernakulam Maradu native Johnny Milton had his mother’s left eye surgery done at Ernakulam Giridhar Hospital. With the help of modern technology, the surgery was performed and discharged without a single day of hospital stay. The complainant approached the Universal Sompo General Insurance Company to recover the medical expenses. But the claim application was rejected by the insurance company considering OP treatment as there was no 24 hour hospital stay. It was in this situation that the policyholder approached the Ernakulam District Consumer Disputes Redressal Commission. If 24-hour inpatient treatment is required but with the help of modern technology the treatment can be completed in less time then the insurance cover is eligible. The court also considered the Insurance Regulatory Authority of India’s (IRDAI) circular that specific injections used for the treatment of myopia would be covered by insurance. The court also found that the insurance company allowed the same claim to another policyholder pending the plaintiff’s demand. Convinced that the proceedings against the insurance company amounted to a breach of service to the policyholder, the court ordered the insurance company to pay Rs 57,720 as compensation within 30 days to the customer whose claim was rejected. The order was passed by a bench of District Consumer Disputes Redressal Commission president DB Binu, members Vaikom Ramachandran and TN Srividya. Advocate Reynolds Fernandes appeared for the complainant. Read on deshabhimani.com
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2023-10-19 12:01:36
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