Mumbai: The Maharashtra State Consumer Disputes Redressal Commission has rejected an insurance company’s contention that a laser surgery to correct one’s vision is a cosmetic surgery. Upholding a district forum order that held The United India Insurance Company Ltd guilty for repudiating a claim on this ground, the commission directed it to pay an Andheri-based senior citizen the insured amount of Rs 50,000 with a compensation of Rs 1,000.
“There is no documentary evidence led by the appellant (insurance company) to demonstrate that lasik surgery (a form of laser surgery) is not a corrective therapy, especially when the complainant was experiencing serious problem in the eye,” the commission said.
K P Desai (61) had regularly subscribed to the mediclaim policy issued by theinsurance company from 1990 till 1997. During the validity period of the last mediclaim, he underwent a corrective lasik surgery in one eye and the hospitalcharges amounted to Rs 50,000. He filed a claim for reimbursement of the hospital charges. However, the insurance company repudiated the claim on the grounds that the operation was purely cosmetic and aesthetic, and did not fall within the purview of the insurance policy. ‘Hosp cost admissible after 5 years of cover’
Mumbai: With The United India Insurance Company Ltd refusing to reimburse his hospital charges amounting to Rs 50,000 following a lasik surgery, Andheri senior citizen K P Desai filed a complaint in 1997. On April 19, 2004, the South Mumbai District Consumer Disputes Redressal forum ruled in Desai’s favour.
The company then filed an appeal against the order. It said the forum had erroneously held that the lasik therapy was not one of the procedures excluded in the terms and conditions of the insurance policy. Lawyer Sureshchandra N Chataule represented Desai in the commission, which pointed out that under the provisions of mediclaim, hospitalization expenditure, including for surgery, is admissible after the completion of five years of continuous insurance coverage. “We find that there is no statement by the company as to how the exclusion clause of the mediclaim comes into operation while denying reimbursement after the completion of the fifth year,” the commission said, dismissing the appeal. —Rebecca Samervel
Source : times of india
Date : 20/3/2013