1 week Ago
Surat: The Consumer Disputes Redressal Commission Surat has ordered a general insurance company to settle the medical insurance claim of Rs 1.16 lakh that it had rejected on the grounds that the patient took treatment from his doctor son. Observing that apart from his son, a group of doctors, including super specialists, had treated the patient, it ordered the insurance company to settle the claim amount with 9% interest and pay Rs 3,000 for mental harassment and Rs 2,000 towards application expenses.
The order was passed recently. As the case goes, Sushila Shah had approached the commission after the insurance company had rejected the claim of Rs 1.16 lakh filed for the treatment expenses of her husband, K P Shah, a retired officer in the department of posts.
Shah's son, Dr Gopal Shah, an MD and a consulting physician, treated his father at a trust-run hospital. Shah had purchased a family floater plan of Rs 3 lakh in Feb 2023 from the United India Insurance Company Limited. In March 2023, her husband developed health complications, after which he was admitted to a trust-run hospital.
The patient was discharged after a week. Later, Shah filed a claim with the insurance company. Following the rejection, Shah approached the commission through her advocates Naresh Navadiya and Jignesh Hariyani.
"The insurance company rejected the claim, saying that the patient was treated by his son. We argued that it is clear from the papers that multiple other doctors also treated the patient, based on which the commission gave an order in our favour," the lawyers said. "I am an expert in a specific area.
But in this case, many super specialists and other doctors were involved in the treatment of my father," said Dr Shah. The commission observed that, "The hospital where the patient was admitted was not of his son. Many specialist doctors work at the hospital and some of them were involved in the treatment of the patient.
Resident doctors were also involved. They are not relatives of the patient.".
