In a move to address a pressing issue raised by the National Consumer Commission chief, the consumer affairs ministry has said that it will take up the matter with the Insurance Regulatory and Development Authority of India (IRDAI) and the Department of Financial Services (DFS), a TOI report stated. The concern revolves around the denial of medical claims by insurance companies if a policyholder is not hospitalized for a minimum of 24 hours for surgery or treatment.
Speaking at an event commemorating National Consumer Rights Day, Justice Amreshwar Prasap Sahi, the president of the National Consumer Disputes Redressal Commission (NCDRC), emphasized the need for a reevaluation of this clause. Justice Sahi highlighted the evolving landscape of medical procedures, where advancements allow for treatments and surgeries to be completed within a few hours.
“There is a condition that if one is not admitted in a hospital concerned for at least 24 hours for surgery, then the claims will not be accepted. This often comes up in case of medical claim and medical negligence cases. Some district forums innovated and ordered that even if it’s 23-and-half hours, the claims have to be paid. They have backed this with reasoning that now several treatments can be done in less than 24 hours. So, there is a need to make the insurance companies aware of this,” stated Justice Sahi.
Union Consumer Affairs Secretary Rohit Kumar Singh affirmed the ministry’s commitment to consumer interests, expressing the intention to engage with IRDAI and DFS to find a viable solution. Singh stated, “In the interest of consumers, we will take it up with IRDA and DFS to find a way out. Earlier we had held consultations on issues relating to the insurance sector on how to bring reforms to make the documents and processes consumer-friendly. Our focus is on finding solutions and reducing the disputes.”
Justice Sahi commended the efforts of district consumer commissions in Punjab and Kerala for passing “landmark orders” on provisions related to medical insurance claims. He cited an instance where the Ferozpur District Consumer Commission held an insurance company responsible for wrongfully rejecting a medical claim based on hospitalization lasting less than 24 hours.
While acknowledging the increased efficiency in complaint resolution, Justice Sahi raised concerns about the challenges faced in executing these orders. He emphasized the need for a standardized scheme for execution to enhance the effectiveness of consumer justice.