It's wrong on the part of an insurance firm to consider someone undergoing physiotherapy as prescribed by a doctor as an 'outdoor patient' and reject the bills, the Navsari District Consumers Dispute Redressal Commission (CDRC) has ruled while granting relief to a 66-year-old Parkinson's disease patient.
It’s wrong on the part of an insurance firm to consider someone undergoing physiotherapy as prescribed by a doctor as an ‘outdoor patient’ and reject the bills, the Navsari District Consumers Dispute Redressal Commission (CDRC) has ruled while granting relief to a 66-year-old Parkinson’s disease patient.
It’s wrong on the part of an insurance firm to consider someone undergoing physiotherapy as prescribed by a doctor as an ‘outdoor patient’ and reject the bills, the Navsari District Consumers Dispute Redressal Commission (CDRC) has ruled while granting relief to a 66-year-old Parkinson’s disease patient.
-
The commission ordered the state-run United India Insurance Company Ltd to reimburse Rs 47,500 physiotherapy bills to the Navsari resident, who underwent physiotherapy sessions for 10 months starting February 29, 2020.
-
Dinyar Gazdar, who had a group insurance policy of Rs 3 lakh for a year starting November 1, 2019, was diagnosed with Parkison’s disease by a doctor at Mumbai’s Lilavati Hospital in January 2020. He was admitted there as an indoor patient for two days.
-
Following the doctor’s advice and prescription, Gazdar went to Navsari’s INS Rehab Physiotherapy Centre from February 29 to December 17, 2020, for treatment. He paid Rs. 47,500 for the treatment during this period and submitted a claim with the insurance firm.
-
The company, however, rejected the bills on grounds that the physiotherapy was given as ‘outpatient’ treatment, and therefore it cannot be approved. Gazdar moved the CDRC on January 11, 2023.
-
‘Firm can’t intervene in doctor’s advice’
-
It was also argued by the insurance firm that Dinyar Gazdar did not produce the documents as asked for by the third-party administrator (TPA).
-
Gazdar argued that physiotherapy was unavoidable according to the doctor.
-
The commission observed that physiotherapy was unavoidable and there was no question of taking this treatment as an indoor patient. It also observed that the insurer has not been able to prove that Gazdar did not need physiotherapy, the doctor had wrongly prescribed the treatment or he had not gone for any physiotherapy.
-
“So the firm cannot intervene or make assumptions in the treatment taken as per the doctor’s advice,” the commission said in its order.
-
“A certificate of a doctor which prescribes physiotherapy was also produced. So, only a doctor and not the insurance firm or TPA can decide on the treatment and related exercises after the indoor treatment.”
Source: Economic Times
