Insurance firm asked to pay treatment cost

MANGALORE, FEB. 26. A two-member Bench of the Dakshina Kannada District Consumer Court has termed illegal an insurance company's refusal to pay for the treatment of a m<149>ediclaim policyholder.

According to a press release here, Doris Menezes had undergone a <149>surgery for disc pro lapse<149> caused by sciatica,<149> a nervous disorder. <149>Ms. Menezes had taken the m<149>ediclaim policy from the National Insurance Company. But the company rejected her claim to reimburse the cost of the surgery.

Mr. Paniyal alleged that the company said she had a history of backache 10 years before obtaining the policy and had concealed this fact from it.

The company contended that it was not bound to pay the cost of treatment. He said any <149>one could develop backache for various reasons. It was only a symptom of a disease. It was not possible to establish that backache was a symptom of disc <149>pro <149>lapse caused by sciatica. He said sciatica was a different disorder and surgery for its treatment had no connection with back pain experienced a decade ago. The company failed to produce independent medical opinion to support its contention.

The court found the company guilty of deficiency in service and ordered it to reimburse medical cost of Rs. 85,000 with 12 per cent interest applicable from October 29, 2001. It ordered a compensation of Rs. 6,000 for the anguish caused.

The Bench, comprising M. Shyam Bhat and Sulochana P. Rao, upheld the complainant's contention and directed the company to reimburse the cost and compensation amount within 30 days of the judgment.