Vadodara Consumer Forum: If you remain admitted in the hospital, the medical insurance company is free to reject the claim. But in an order of the Consumer Forum, it was said that the person getting the medical insurance is entitled to take the claim in less than 24 hours.
Medical Insurance: If you have got medical insurance for yourself and your family, then this news is useful for you. You must have often heard about medical insurance that in order to get a claim, it is necessary for the patient to be admitted to the hospital for at least 24 hours.
If you are admitted to the hospital for less than this, then the medical insurance company is free to reject the claim. But in an order of the Consumer Forum, it was said that the person getting the medical insurance is entitled to take the claim in less than 24 hours. Let us know what the court said in its order-
Fast treatment by modern machines
A similar decision has been given by the Vadodara Consumer Forum in a case related to medical insurance. Consumer Forum says that it is not necessary that the person has been admitted to the hospital for 24 hours to claim the medical insurance. Nowadays treatment is being done fast by modern machines and doctors also discharge the patient. In such a situation, the patient does not need to stay in the hospital in less than 24 hours.
Order to make payment to the patient
The Medical Insurance Company has been ordered by the Consumer Forum to make payment to the patient. Actually, Rameshchandra Joshi, a resident of Vadodara, had filed a complaint against the National Insurance Company in the Consumer Forum in 2017.
Joshi said that his wife had a problem of dermatomyositis in 2016. During this, he was admitted to Lifecare Institute of Medical Science and Research Center in Ahmedabad for treatment.
Claim was not given citing clause 3.15
Doctors discharged Joshi’s wife the very next day after treatment. Joshi demanded payment of Rs 44468 from the insurance company. But the insurance company refused to pay Joshi. The insurance company refused to pay citing clause 3.15. Joshi had filed a complaint against this in the consumer forum. The insurance company argued that the claim was not settled because the patient was not admitted for 24 consecutive hours.
Joshi placed all his documents in front of the consumer forum and requested to get the money. Joshi claimed that his wife was admitted on 24 November 2016 at 5.38 pm. The next day, on 25 November 2016, he was discharged at 6.30 pm.
The forum said in its decision that it should be assumed that the patient was admitted to the hospital for less than 24 hours. Still he is entitled to get the claim of medical insurance. In the modern era, new methods and medicines have been developed, in such a situation, doctors treat them accordingly.
