MUMBAI: Reprimanding insurance companies for being rigid and rejecting claims on flimsy grounds, in two separate instances, a consumer forum directed reimbursement to patients who underwent sequentially programmed magnetic field (SPMF), an advanced treatment for joint pain.
While in the case of Kandivali-based Govindlal Shah, The New India Assurance Co Ltd and TTK Healthcare TPA Pvt Ltd have been directed to pay him around Rs 2.4 lakh (Rs 1.40 lakh claim plus interest and compensation), United India Insurance Company Limited and Medi Assist India TPA Pvt Ltd will have to pay Sion-based Gul and Kavita Bhatia a total of around Rs 1.23 lakh (Rs 88,000 claim amount plus interest and compensation).
Among the grounds for rejecting the claims, the insurance companies had said that the treatment, originally known as Quantum Magnetic Resonance (QMR), was not included in their policies and that hospitalisation in both cases was for less than 24 hours.
However, in the case of Shah, who had submitted the complaint in 2013, the forum held that the insured should not suffer due to the rigid, unreasonable and absurd clauses of the insurance policies despite being blessed with advanced technology and specialized infrastructural facilities. The forum said that advancement is meant to help to improve quality of life of the patient, save time and prevent unnecessary hospitalisation.
“Considering the benefits of advanced technologies, various insurance companies are required to think in the interests of its consumers while drafting the terms and conditions of the policies, instead of focusing on rejecting the genuine claims on rigid and flimsy grounds,” the forum said.
In both cases, the consumer forum was of the opinion that the treatment, which is special in nature and which falls under the category of advanced technology therapy, does not require hospitalisation. It said that in this treatment, radio waves are given to the patient carefully with controlled frequencies by a highly innovative machine which is technologically advanced to carry out this treatment without hospitalisation. “It has proven to be effective and provide huge relief to the patient, eliminating the need for knee replacement surgery…” the forum observed.
It also held that both had received the treatment at registered health care centres which had fully qualified doctors, radiologists and physiotherapists. “While repudiating the claim of the complainant, the opposite parties have not proved any documentary evidence to establish that SPMF treatment is not recognised by Indian Medical Council. Hence, the objection raised by the opposite party would not be acceptable. It is the duty of the opposite party to place on record authentic documents and prove it, but it has failed to do so,” the forum held in Kavita Bhatia’s case.
Both Shah and Bhatia submitted they opted for the noninvasive treatment as severe knee pain left them unable to carry out routine work. While Shah was treated in 2012, Bhatia availed it in 2014.