Mumbai: Medical services firm directed to reimburse a patient

A Churchgate resident in Mumbai will be receiving a reimbursement of Rs 7.65 lakh, after the order issued by the consumer redressal forum to a medical service firm and an insurance company involved in the case.

The issue came to highlight after they refused to repay the patient’s (the complainant, 78 yr old Gool Sawhani), hospital bills. The firm under the case is Life Line Global Ltd which provides medical services to its members before and during hospitalization for treatment and even after discharge.

As per the status quo on the case, the complainant, Gool Sawhani (78), had moved the forum against Life Line Ltd, which provides aid during hospitalization, and United India Insurance Company Ltd after they refused to refund the money she had incurred for his knee transplantation surgery at Breach Candy hospital in March 2005.

She has submitted the evidence based documents required for her claim which includes the doctor's certificate. She had also shared different test reports which were conducted at the hospital before the surgery.

However, the firm refused on the grounds that it was an existing ailment and hence, she was ineligible for medical expenses. The firm further implied on the rejection of the case that original documents were not submitted about the treatment, and discharge card despite demanding it.

As reported by TOI, the forum comprising Justice A Z Telgote and S R Sanap said the complainant had mentioned about arthroscropy (a procedure for diagnosing and treating joint problems) done on her left knee in 1999 for osteoarthritis.

The doctors gave in writing that it was necessary to operate on her right knee. The forum held that there was a lapse in the service, considering that Life Line denied reimbursement despite she submitting all documents related to the medical tests.

Advocate Geeta Handa-Khanuja appearing for Sawhani, said United India Insurance Company had a tie up with Life Line Global and hence the former was made a party. United India Insurance's claim that the certificate issued to her was bogus was rejected by the forum. The forum said if that was the case, the insurer would have initiated criminal or civil action against Sawhni and Life Line.