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Gujarat Consumer Court Orders Insurance Company to Cover Doctor’s Medical Bills after Treatment at Own Hospital


Shah again contracted the virus and was admitted to his own hospital for five days on November 11. (Representational Image: Reuters)

The doctor’s medical claim was rejected as he was treated in his own hospital by a family member

A Gujarat court has ordered that a doctor is entitled to medical insurance claim for treatment in his own hospital. The petitioner, Dr Indravadan Shah, had filed a complaint in the Consumer Protection Court in June 2021 against Niva Bupa Insurance for non-payment of claim.

In his complaint, Shah stated that he was infected with Covid-19 on October 31, 2020. “I was treated at my hospital and by my son till November 6 after which I incurred an expenditure of Rs 84,055. The insurance company rejected the claim.”

The claim was rejected as the doctor was treated in his own hospital and by a family member.

Shah again contracted the virus and was admitted to his own hospital for five days on November 11. He was treated by his son Dr Mosam.

This time Shah again paid Rs 61,777 sum assured claim, which Niva Bupa rejected citing the same reason as before. Shah then contacted the insurance firm and inquired about his issue. He came to know that there was no clause in the policy documents that say that the insured cannot be treated by his relatives and subsequently moved the Consumer Court.

After the hearing, the Chairman, Vadodara Consumer Disputes Redressal Commission, ordered Shah to be paid Rs 1.69 lakh from the insurance company.

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