Insurance Co cannot deny reimbursement

An insurance company cannot escape the liability of reimbursing expenses incurred on life saving external aids like pacemaker and C-PAP (Continuous Positive Airway Pressure) machine to patients, the Delhi Consumer Commission has said. "Those equipments are reimbursable which are essential for treatment of disease and necessary for saving life, for instance pacemaker and artificial limbs," Commission President Justice J D Kapoor said. The Commission rejected contention of National Insurance Company Ltd (NICL) that the terms of the insurance policy did not allow it to reimburse the cost of a machine which is used as an external aid. "Any beneficial legislation or for that purpose beneficial contract like the insurance has to be provided and receive beneficial interpretation and if there are more than one interpretation available then that which goes in favour has to be accepted," the Commission said. The Commission's consumer-friendly observations came on an appeal of the NICL against an order of a district forum directing it to pay Rs 1.07 lakh with interest to Gian Chand, a resident of Karol Bagh here. The Commission partly allowed the appeal and waived off the interest on the awarded compensation. Chand, who was suffering from chronic snoring trouble, was denied reimbursement claim by the NICL for C-PAP. "So far as C-PAP is concerned, any patient is having a disease cannot survive long, if such system is not used (by him). Rather, he can die any moment if such a device is not used... Thus, meaningful interpretation of the Insurance clause has to be provided," the Commission also comprising member Rumnita Mittal said.
Source-Economic Times