Surat: The consumer court in Navsari has ordered a private insurance company to pay the mediclaim amount to a 52-year-old woman who had undergone treatment for Arnold Chiari malformation, a structural defect in the base of skull and cerebellum.
The insurer, Oriental Insurance Co., had rejected the claim of Navsari resident Paras Patel on the grounds that the condition for which she took the treatment fell under ‘genetic disease’ category, which is exempted from the policy clause.
Patel had purchased mediclaim policy of Rs one lakh for the period of one year starting December 2018. On January 16, 2019, she suffered back pain and underwent surgery at a private hospital in Surat. She then filed her claim for treatment cost of Rs 1.66 lakh incurred.
But the company rejected her claim in February 2019 stating that ‘Arnold Chiari Syndrome’ falls under genetic disease group and as per the policy clause, genetic disorders and stem cell surgeries are in the excluded category.
However, the court observed that Patel had not undergone stem cell surgery but taken treatment for ‘Arnold Chairi malformation with C4-5 disc protrusion K/C/O-hypothyroidism’ due to her age and therefore it was not a treatment for genetic disorder treatment.
“Moreover, the complainant had been purchasing this policy since 2009 and had she indeed been suffering from genetic disorder, she would have taken treatment in four-five years. Whereas this treatment has been taken after 10 days. So, it can’t be believed that it was genetic disease,’the court observed.