Doctors entitled to Medical Insurance payment for treatment at Own Hospital: Consumer Court

Vadodara: The District Consumer Disputes Redressal Commission in Vadodara recently held that doctors can claim medical insurance for treatment at their own hospital. 

Such an order has been passed by the Gujarat Consumer Court while it was considering the complaint by Dr Indravadan Shah, who had allegedly been denied payment of insurance claim for his treatment, reports News 18.

The matter goes back to October 31, 2020, when Dr. Shah got infected with Covid-19 and therefore he had to get treatment in his own hospital. For this, an amount of Rs 84,055 had been spent by him and he claimed the same amount from the Niva Bupa Insurance company.

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However, the insurance company rejected his claim on the basis that the doctor had been treated in his own hospital by a family member. Referring to this, Dr. Shah was quoted stating in his complaint by News 18, "I was treated at my hospital and by my son till November 6 after which I incurred an expenditure of Rs 84,055. The insurance company rejected the claim."

Following this, the doctor again got infected with Covid-19 again and he got admitted to his own hospital and received treatment for five days on November 11. This time, he was treated by his son Dr Mosam.

For the second time, Dr Shah had to pay Rs 61,777 for treatment purpose and claimed the money from the Insurance Company. This time as well, the company rejected the claim on the same ground. 

When Dr Shah inquired about the matter from the Insurance Company, he got to know that there was no clause in the policy documents stating that the family members cannot treat those covered under the insurance.

Therefore, he filed the complaint under the Consumer Protection Court in June 2021 against the Insurance Company alleging non-payment of the claim.

After taking note of the matter, the Chairman of the Vadodara Consumer Disputes Redressal Commission directed the Insurance Company to pay Dr Shah Rs 1.69 lakh.

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