Consumer forum asks New India Assurance Company to pay for mediclaim policy

The Pune District Consumer Disputes Redressal Forum (consumer court) has ordered New India Assurance Company Limited to pay more than Rs 75,000 to Sapna Nagrani from Shastri Nagar for refusing a claim for hysterectomy operation, confusing it with appendectomy (the removal of swollen appendix), for which she was earlier operated upon.

Nagrani had opted for a mediclaim policy from New India Assurance between February 4, 2008 and January 1, 2009, which was renewed for another year. On March 5, 2009, she was detected with abdominal hysterectomy and admitted to Sadhu Vaswani Mission’s medical complex at Inlaks and Budhrani Hospital to be operated for the same.

She was discharged on March 11, 2009 after which she filed for an insurance claim of Rs 75,879 with the company. The firm refuted the claim stating, “this claim was for subacute intestinal obstruction with mass in pelvis (right side). It was evident from the submitted documents that the patient had undergone intestinal resection and appendectomy in 2005. Hence the claim is not admissible…”

Nagrani had produced an expert’s report stating that in 2005, she had ‘Ischaemic bowel disease and far necrosis in mesentery’, which had nothing to do with fibroid uterus.

The report was given by Dr V M Bapat, the chief consultant histopathologist. However, when the insurance company refused to entertain the claim, she filed a complaint with the consumer court on February 5, 2010 through her lawyer Dnyanraj Sant against Paramount Health Services private limited and New India Assurance.

She had demanded the hospitalisation expenditure of Rs 75,879 with nine per cent interest.

While Paramount never represented themselves in court, the insurance company, through their lawyer Sanjit Shenoy, stated that Nagrani had taken the policy through Union Bank of India, but had not made the bank a party to the suit.

They also stated that the premium was paid from Mumbai and the policy, too was taken from Mumbai. Hence, the Pune court has no jurisdiction on this matter.

However, the court refused to accept the argument stating that the court had jurisdiction to hear the complaint as Paramount had a branch in Pune.

“We produced a certificate dated September 15, 2009 issued by Dr Sudhir Lokari from department of surgery of Inlaks and Budhrani hospital stating, ‘This is to certify that Sapna Nagrani was operated on 7/3/2009 for excision of abdominal mass with hysterectomy and intestinal adhesiolysis was done. Abdominal mass excision and hysterectomy is independent of previous operation which was done in 2005,” Sant said.

 

 

AADITI JATHAR LAKADE http://www.indianexpress.com/news/consumer-forum-asks-insurance-firm-to-pay-up/953214/0