United India Insurance and MedSave Health Care Held Guilty

On a complaint filed by Consumer Education and Research Society (CERS) and Sudhir Sharma, Ahmedabad, the Consumer Disputes Redressal Forum, Ahmedabad City, held MedSave Health Care as well as the Chennai and Ahmedabad offices of United India Insurance Company Limited guilty of deficiency in service and unfair trade practice. 

The Forum ordered all three opposite parties on 9 April 2010 to pay Sharma jointly and severally Rs.2,17,500 with 7 per cent interest from the date of complaint till the payment. The three should also pay him severally and jointly Rs. 3,000 as compensation for mental agony and harassment, and Rs. 1,500 as cost, the Forum added.

Sharma held a Mediclaim policy of United India Insurance for himself, his wife Deepika, and their children during 2005 and renewed it regularly. Deepika was hospitalised from 16 to 23 February 2006 for bariatric surgery (gastric bypass surgery). Later, she submitted a bill for Rs.2,23,740 and all supporting documents. United India Insurance repudiated her claim on the grounds that bariatric surgery was a cosmetic surgery and, therefore, her claim was not admissible under Clause 4.5 of the policy. (The bariatric surgery undergone by Deepika does not come under the Clause; there is no mention of this disease in the exclusion clause of the policy.)

The Sharmas approached CERS which wrote to United India Insurance but there was no response. Sharma even submitted a certificate from Dr. Mahendra Narwaria, of Sterling Hospital, that “bariatric surgery is not cosmetic surgery but is a life-saving surgery…There is no point in harassing my patient and causing them (the Sharmas) mental trauma…”

CERS and Sharma issued a legal notice to Medsave Health Care and United India Insurance, Ahmedabad and Chennai offices. When this too met with silence, they complained to the Forum on 26 March 2009, alleging deficiency in service and unfair trade practice. They claimed Rs. 2,23,740 with 12 per cent interest from the date of the claim till payment and realisation of the claim amount. The complainants also demanded a Rs. 25,000 compensation for Sharma’s mental agony and harassment and Rs. 5,000 towards cost, payable to each of the two complainants.

United India Insurance and Medsave Health Care contested the validity of the complainants’ statements, the tenability of the complaint under the Consumer Protection Act, the jurisdiction of the Forum and even disposed of Dr. Narwaria’s certificate as one that cannot be relied upon. They pleaded for dismissal of the complaint with cost.

The Forum, which admitted the complaint, maintained that the complainants had established their case well and issued its order on 9 April 2010.

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