The Ernakulam Consumer Disputes Redressal Forum has held that an insurance company is not liable to make any payment under the policy conditions for the alternative treatments other than Ayurveda and homoeopathy undergone by the insured. The Forum made the ruling while dismissing a complaint against the refusal of the National Insurance Company to reimburse the medical expenses of treatments undergone by an elderly person.
According to the complainant, his wife was suffering from severe osteoarthritis on both her knees and she was admitted in a hospital in Kochi. She was advised to take cytotron therapy, claimed to be an alternative treatment to knee replacement surgery. He had spent ₹1,07,500 for her treatment.
Though he had presented the bills along with the necessary documents, the claim was repudiated by the insurance company saying that cytotron was not a proven procedure as per medical council and therefore the claim was not admissible as per exclusion clause in the the policy conditions.
According to the complainant, the refusal of the claim would amount to deficiency in service as the treatment undergone by his wife was done in order to avoid a joint replacement surgery. Besides, it was done by a senior orthopaedic surgeon with the help of psychotherapist and technicians.
The Forum observed that since the treatment undergone by the woman was an alternative therapy other than Ayurveda and homoeopathy as per the terms and conditions of the policy, the rejection of the claim could not be termed as a deficiency in service.
