Ayurvedic treatment valid: Consumer Dispute Redressal Forum

Ahmedabad: Patients are entitled to medical insurance claims for ayurvedic treatment, subject to certain conditions, a consumer court recently ruled while ordering an insurer to pay 25% of sum assured to a claimant. The court said that the insurance company cannot deny claim to patients who got
treatment from registered ayurvedic doctors at government-approved ayurvedic hospitals.
Gaurav Mehta was treated in April 2017 at Charak Health Centre at Paldi as an indoor patient for cold and constipation. After he was discharged, Mehta claimed reimbursement of Rs 32,800, the amount he
spent on his treatment.
The insurance company flatly refused to pay the sum on the grounds that it cannot pay for ayurvedic
treatment under a certain policy condition (3.5). Mehta approached the court claiming that the
Mediclaim policy has a provision for 25% of the sum insured to be paid under policy condition 3.6, if
treatment was obtained in a government hospital or a hospital registered with the National
Accreditation Board for Hospitals and Healthcare Providers. The insurance company opposed Mehta’s
complaint and stuck to its position that it could not reimburse money paid for ayurvedic treatment. The
patient had got treated at a private nursing hospital and was not eligible for the claim.

After hearing the case, the consumer court concluded that Mehta is eligible for 25% of the sum insured.
He cannot have the entire claim amount, but the insurer ought to pay him Rs 25,000 with 8% interest.
In this case, the Consumer Dispute Redressal Forum, Ahmedabad city, ordered New India Assurance
Company Ltd to pay Rs 25,000 towards medical expenditure incurred by a resident of Sabarmati, Gaurav
Mehta. It also told the insurer to pay Rs 3,500 extra for causing mental agony by denying him the claim.
This was a deficiency in service and an unfair trade practice by the company, the court held in an order
passed two weeks ago.

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