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Surat Consumer Court has given a big decision. This decision will provide great relief to the common man. In fact, many insurance companies refuse to give claims to people because the doctor is their relative. Now the Consumer Court has given an important decision on this issue that the insurance company cannot stop the claim on getting treatment from a relative doctor. The court clearly said that choosing one’s own doctor, even if he is a relative, is a fundamental right granted by the Constitution and the insurance company cannot snatch it away.
Nowadays, taking health insurance has become a necessity for everyone. In this era of inflation, one becomes dizzy after seeing the hospital bill and sometimes even the insurance companies are reluctant to pay the claim and make the excuse that the doctor is your relative and that is why the bill has been made so high. The Consumer Court of Surat has given a very important decision on this. Now no insurance company can say that the patient will be given a higher bill just because the doctor is his relative, nor can the company stop the patient from getting treatment from his family or relative doctor.
The court clearly said that choosing one’s own doctor, even if he is a relative, is a fundamental right granted by the Constitution and the insurance company cannot snatch it away. Meaning, now even if you get treatment from your uncles, aunts or brothers and sisters who are doctors, your claim will not be rejected. Surat Consumer Court ordered the insurance company to pay the entire hospital bill of Rs 1.91 lakh for the treatment of the 57-year-old woman’s husband. The court said that it is wrong to stop the claim because the relative is a doctor, hence the company will have to pay interest and court expenses along with the bill.
The company rejected the claim
The woman’s mediclaim policy was worth Rs 8 lakh which was valid from January 17, 2024. Meanwhile, her husband was admitted to the hospital on April 12 due to a tumor or neoplastic lesion on his head and was discharged the very next day. But the insurance company had rejected the claim, the reason given being that there is exclusion clause 50 which says that if the patient is being treated by a doctor who is a relative of the policy holder, then the claim will not be given.
Consumer Court gave this decision
The woman filed a case against the insurance company in the Consumer Dispute Redressal Commission of Surat on July 11, 2024. The court heard both the parties and found that it was wrong to stop the claim because the relative was a doctor because choosing a doctor is a fundamental right of everyone. The commission ruled that the insurance company will have to immediately pay the bill of Rs 1.91 lakh for the entire claim.
Apart from this, Rs 12 thousand will have to be paid for mental problems and Rs 8 thousand will also have to be paid as application fee. This decision shows that insurance companies cannot arbitrarily stop claims, especially when the treatment is from a relative doctor.
