AHMEDABAD: A consumer dispute commission ordered an insurer to pay a medical insurance claim for Covid-19 treatment, after the patient’s claim was repudiated on the ground that he had got homeopathy treatment at his home.
This case involved Hiren Shah, a resident of Paldi, who taken out a special Corona Kavach Mediclaim policy for coverage up to Rs 5 lakh from Oriental Insurance Co Ltd. He contracted Covid in September 2021 and Dr I M Patel of Jalaram Homeopathic Clinic advised him to get home care treatment. He incurred expenses of Rs 71,400 on this treatment. Sheth had been taking only homeopathy treatments for the 18 years and stuck to it during Covid too.
The insurance company refused Sheth’s claim saying his home care treatment and that too by the Ayushmethod of homeopathy was not covered under the policy. Sheth sued the insurer with the Consumer Dispute Redressal Commission, Ahmedabad (City) stating that the Insurance Regulatory and Development Authority has given directions for thorough review of Covid claims by a claims review committee before rejection, but no review conducted in his case. Hence, the repudiation was illegal.
The insurer asserted that the patient was not hospitalized and had obtained treatment through the Ayush method, which was not covered under the policy.
After hearing the case, the commission said most of the policy clauses covered home treatment. Moreover, during the Covid times, there was a scarcity of beds in hospitals. The patient had only taken homeopathy treatment for last 18 years and did the same for Covid treatment on the advice of his treating doctor. “Homeopathy is a kind of treatment and whether to take allopathy, homeopathy or ayurvedic treatment depends on person to person. If allopathy is permitted at home by the opponent (insurer), then they cannot have a restriction on taking homeopathy treatment at home,” the commission said and held the rejection of the claim to be totally baseless. It ordered the insurer to pay the amount with 8% interest and Rs 5,000 extra as compensation for mental agony and legal expenditure.
