Health Insurance : Pay insurance for ayurvedic treatment at private hospital

The Mumbai Suburban District Consumer Disputes Redressal Forum recently ordered an insurance company to pay for the treatment of a Parkinson’s disease patient from Santa Cruz who had undergone ayurvedic treatment.

Holding New India Assurance Company Ltd guilty for deficiency of service, the forum ordered it to pay Kantilal Hariya Rs 62,000 along with Rs 22,500 interest. Hariya will also receive Rs 10,000 as compensation. 

In a complaint filed with the forum on May 14, 2009, Hariya said he underwent treatment at an ayurvedic hospital for Parkinson’s disease. The treatment lasted from April 7, 2008 to May 6, 2008 and Hariya then sent his claim to the insurance company. But the company replied that according to a new clause, expenses incurred for ayurvedic, homeopathic or unani treatment were admissible up to 25 % of the sum insured provided the treatment was at a government hospital. Hariya’s claim was rejected as it was not a government hospital.

Hariya said such conditions were not mentioned while availing of the insurance policy. He said he had undergone similar treatment earlier and was reimbursed. Hariya sent a notice in January 2009 and filed a complaint when he didn’t get a reply.

The insurance firm told the forum the condition was introduced when Hariya renewed his policy in 2008. But the forum said Hariya was not informed of the change. It said that when the policy was renewed and the changes were introduced, Hariya should have been told about them. “The change was made unilaterally and such a change was voidable,” the forum said.