HC directs Insurance firm to reimburse treatment cost

The Madras High Court today directed United India Insurance company to reimburse treatment expenses of Rs 44,581 with nine per cent interest to a petitioner, who got her baby admitted to a non-network hospital due to an emergency.
Justice R Subbiah, allowing a petition filed by one S Dhanalakshmi, a school teacher of the City Corporation Middle school here, said HC had already advised the state to make it clear that a person's claim should be considered on satisfactory reason that they were unable to get treated in a network hospital, but had been advised to go to a non-network hospital.

In this case the petitioner's son had vomited and she was under the impression it was just food poisoning. But his condition had worsened and she had taken the child to a nearby hospital, where doctors diagnosed it as obstructed hernia and said he should be operated immediately.
On their advice, her son had undergone emergency surgery. The Joint director of health had given a certificate that it was a genuine case. The Collector had also recommended her case. Under the circumstances, the insurance firm could not reject her claim on the ground that treatment was done in a non-network hospital, the Judge said.

The woman had filed the claim on April 30, 2014 and hence the amount of Rs 44,581 would carry nine per cent interest,the judge said, adding the money should be settled in four weeks.
The petitioner had joined New Health insurance scheme 2012 and was subscribing to it regularly.