Pune: Ismail Abdul Sayyed, a resident of
Wetale in Khed taluka has emerged victorious as based on his petition the
District Consumer Court has directed a mediclaim insurance company to pay
him Rs, 14,453 as claim settlement. The court has also imposed Rs. 5000 cost
over and above the sum as well.
The Consumer Court took this decision as it held
that the insurance company had wrongly rejected Sayyed’s claim on
grounds of having been treated by an ayurveda practitioner instead of an
allopathic doctor.
Citing the Deputy Secretary, Government of
India’s May 28, 2007, letter, allowing ayurveda practitioners to
practice allopathy and the valid certificate of the complainant’s doctor
from the Maharashtra Council of Indian Medicine for practice, the bench of
VP Utpat, Kshitija Kulkarni, issued the order in favour of Abdul Sayyed.
“The insurance company has caused
deficiency in service by wrongly repudiating the genuine claim of the
complainant,” the bench ruled.
Ismail Abdul Sayyed, had subscribed for a `Happy
Family Floater’ mediclaim policy offered by Wadgaon Sheri-based M D India
Healthcare Service Private Limited, a third party agent (TPA), on behalf of the
Oriental Insurance Company Limited. The policy was valid for the period between
December 20, 2012 and December 19, 2013.
Sayyed who suffered from typhoid after the
purchase of policy, was admitted as an indoor patient at a private hospital in
Shirur from December 6 to 10, 2013.
On recovery, Ismail Abdul filed for a
reimbursement claim of Rs 14,453, as cost of his medical treatment under the
policy. However, on December 15, 2013, the TPA informed him that his claim was
repudiated on the ground that an ayurvedic doctor gave allopathic treatment to
him. Undeterred, Ismail A. Sayyed approached the Oriental Insurance Company
with the the doctor’s credentials and permission to practice allopathy.
The insurance company however, refused
maintaining its previous stand on the issue. It pointed out one of the clauses
in the policy’s terms and conditions as clearly defining
medical practitioner as ” A qualified person of any state of India or
Council for Indian Medicine or for homeopathy set up the government of India or
a state government and is thereby entitled to practice medicine within its
jurisdiction and is acting within the scope and jurisdiction of his license.”
In the face of opposition from the insurance
company, Ismail moved the consumer court. The court stood for him basing
its judgement on the Deputy Secretary, Government of India’s letter allowing ayurveda
practitioners to practice allopathy and the doctor’s certificate submitted in
court by Sayyed reports TOI.
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