Page 54 - Insurance Times March 2024

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Car owner and insurer asked to pay Rs. which can be used at home including the CPAP are excluded
under a certain clause of the policy, bought by Joshi, who
2.45 crore to crash victim kin then filed a complaint in the Vadodara District Consumer

In one of the highest payouts awarded recently, a Motor Disputes Redressal Commission (additional) in December
Accident Claims Tribunal ordered a car owner and driver, 2022.
and insurance company to pay Rs 2.45 crore with interest The complainant said that he was suffering from
to the family of a Bhabha Atomic Research Centre (Barc) nasobronchial hyperactivity, obstructive airway disease, obe-
employee who died 10 years ago when a four-wheeler hit sity hypoventilation syndrome (OHS), and the said condition
his bike at Anushakti Nagar, reports Rebecca Samervel. The if not treated early may be effectively life-threatening.
tribunal held the car owner, Noble Jacob liable.
He also said to manage smooth breathing of OHS patients,
The victim, Priyanath Pathak, earned a monthly salary of
use of the BiPAP machine - a life-saving device - is essen-
Rs 1.26 lakh. This was a factor in deciding the compensa- tial. Joshi said in the forum he was advised by the medical
tion. Pathak's wife and three daughters had moved the
professional to take BiPAP during the discharge from the
tribunal on Dec 19, 2014, against Jacob and New India hospital and thus the machine was an integral part of the
Assurance Co.
treatment. He also said that he wasn't supplied or explained
the terms and conditions of the policy.
Pay claim amount for BiPAP machine,
The forum noted the words 'items that are subsumed into
court tells insurance firm costs of treatment' that was a part of the lists in the policy
A patient is entitled to get reimbursement of durable equip- and observed that BiPAP machines are to be included in the
ment used for medical treatment after getting discharged cost of treatment.
from the hospital. Vijay Joshi had filed a complaint against Taking a note of the hospital's discharge summary and ad-
the National Insurance Company Ltd that accepted only a vice of using BiPAP, the forum said, "Thus the indoor hospi-
partial insurance claim citing that the BiPAP machine isn't talization was to culminate into a definite treatment there-
covered by the policy. after and even at home. Therefore, it should have been
According to a Vadodara consumer forum gave this judg- considered as the cost of hospitalization treatment."
ment, while hearing the case of Joshi, a resident of Alkapuri. The forum further added that a clause in the policy also
Joshi, a senior citizen, was admitted to a private hospital in permits post hospitalization expenses incurred 60 days im-
October 2021 and he was diagnosed with a disorder simi- mediately after the insured person is discharged from the
lar to sleep apnea. He lodged an insurance claim of Rs 1.13 hospital.
lakh, but the insurance firm transferred only Rs 33,837 to The consumer forum ordered the insurer to pay Rs 79,562
his account. with nine per cent interest to Joshi apart from Rs 3,000 for
The insurer argued that all the external durable equipment mental agony and Rs 2,000 towards the legal costs.

48 March 2024 The Insurance Times