Ahmedabad: A consumer commission in Ahmedabad ordered an insurance company to reimburse expenses for ayurveda treatment after firm refused to pay for treatment other than allopathy.A woman from Chandlodiya underwent ayurvedic treatment as an inpatient for internal haemorrhoids in Feb 2022 from a private ayurveda hospital. She incurred an expenditure of Rs 15,800. As she had a health cover of Rs 5 lakh from Star Health and Allied Insurance Co Ltd, she claimed reimbursement.The insurer rejected her claim, citing a clause in the insurance policy that stated she was not entitled to reimbursement for any treatment other than allopathy.The consumer dragged the insurer to the District Consumer Dispute Redressal Commission, Ahmedabad (Main), alleging deficiency in service and unfair trade practice for the denial of claim.The insurance company justified its repudiation of mediclaim for ayurvedic treatment and cited its exclusion clause No. 39. The commission did not agree with the insurer’s argument regarding the exclusion clause. It noted that the discharge summary showed ayurvedic treatment by a qualified MS (Ayu) doctor. It also relied on policy wording indicating Ayush treatment was payable subject to conditions and referred to an Insurance Regulatory and Development Authority (IRDA) circular dated Jan 10, 2017, which directs insurers to cover Ayush (Ayurvedic, Yunani, Unani, Siddha and Homeopathy) treatment taken in govt or registered hospitals. The ayurvedic hospital the consumer took treatment in was a registered hospital.The commission stated, “The opponent has not been able to justify why they have repudiated the claim amount of Rs 15,800 under the mediclaim. We agree with the complainant that the claim has wrongly and illegally been repudiated, hence, in the light of what is discussed above, we are of the view that the opponent has committed deficiency in service and unfair trade practice in repudiating the claim of the complainant.”The commission ordered the insurance company to reimburse the claim amount with 8% interest along with Rs 3,000 compensation for mental agony and litigation expenses.
