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.