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PREM PRAKASH   29 April 2024

Judgemnts against insurance companies for denying/rebuttal of mediclaim citing pregnancy clause

on 13.09.2023 my wife  ( 33 week pregnant )was admitted around 10.30 Am in emergency ward of Hospital, due to pain in her stomach, chest, continuous vomiting & problem in breathing.  

duty doctors immediately put her on oxygen and gave her some initial treatment and done some medical tests (Doppler, USG and some other vital test to check fetal status and condition.)

when they found everything perfect with fetal and pain is not related to labor pain they proceed for further diagnosis & treatment.

on 13.09.2023 around 10.30 PM they shifted patient to ICU from gyane ward as her BP and other vital fall very low (30/60 or 35/60).

on 14.09.2023 around 5.30 AM Medical team/Doctors told to me that condition of patient is very serious and her BP and other vitals are very alarming and not getting stable and life threatening for both mother and child & advised my client for pre mature delivery of baby, as they cannot treat her further with heavy dose of medicines which can impact and threatful for the life of infant/baby.

 

on the same day of i.e. of 14.09.23 around 8.00 Am patient goes for emergency LSCS and a baby girl was born (Baby was also shifted to NICU due to some pre term birth-respiratory complications.) and patient was shifted to ICU for further treatment. 

on 17.09.2023 patient was shifted from ICU to ward after stabilization.

on 18.09.2023 at the time of discharge of hospital informed me that your claim for wife bills is not passed citing that its related to maternity complications.

My initial purpose of admission is not related to labor pain or maternity. There was a infection on her stomach due to which pain occurs and its her low bp and vital which force for premature delivery of baby to save both.

 

I am going to file the consumer case against insurance company. You are requested to please share any judgments any you valuable feedback.

 

 

 



Learning

 2 Replies

T. Kalaiselvan, Advocate (Advocate)     29 April 2024

You can very well collect the details and particulars of treatment and file a case against the insurance company for deficiency in service and also for unfair trade practice for not fulfilling their promise made at that time of you buying the insurance policy.

 

1 Like

P. Venu (Advocate)     29 April 2024

Yes, in the given facts, you may seek legal remedies.

You can as well take up the issue with the Insurance Ombudsman/IRDA. 

1 Like

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