Citing Section 21(4) of the Mental Healthcare Act, 2017, as per which, “Every person with mental illness shall be treated as equal to persons with physical illness in the provision of all healthcare,” the District Consumer Disputes Redressal Commission directed The Oriental Insurance Company Limited to settle the claim of a Mohali resident who was diagnosed with psychiatric problem. The redressal commission directed the private company to pay Rs 25,000 as compensation and cost of litigation to the complainant.
The complainant, Nirankar Singh, stated that he obtained a ‘Happy Family Floater Policy’ from The Oriental Insurance Company Limited with the hope that at the time of need he would get quality medical care without putting himself under much financial burden. On being diagnosed with a psychiatric problem, he applied for medical claim under the aforesaid policy, but the same was rejected by the insurance firm on September 27, 2018, on the ground that the disease was excluded as per Clause 4.8 of the policy.
Accordingly, Singh made a representation to the insurance firm and stated that medical insurance also covers mental health as per the Mental Healthcare Act, 2017, and that his claim must also be covered as per the directives issued by the IRDAI.
However, his plea was of no avail, hence he filed a formal complaint at the consumer commission.
In reply to the complaint at the commission, The Oriental Insurance Company Limited pleaded that the case summary clearly mentions ‘senile dementia’ under the heading ‘diagnosis’ and the same is excluded as per clause 4.8 of the policy, and thus the claim of the complainant was rightly rejected.
After hearing the arguments, the consumer commission held, “Section 21(4) of the Mental Healthcare Act, 2017, reveals that every insurer shall make provision for medical insurance for treatment of mental illness on the same basis as is available for treatment of physical illness. All insurers are directed to comply with the aforesaid provisions of the Mental Healthcare Act, 2017, with immediate effect. According to the said Act, every person with mental illness shall be treated as equal to persons with physical illness in the provision of all healthcare. The Act further says that every insurer shall make provision for medical insurance for treatment of mental illness on the same basis as is available for treatment of physical illness. Thus, to our mind, the act of the opposite party (insurance company) of refusing to deal with the illness of the complainant despite the aforesaid enactment, and propelled this unwarranted, uncalled for litigation upon the complainant, amounts to deficiency in service and their indulgence into unfair trade practice.”
The district commission, thus, directed the insurance company to immediately settle the claim of the complainant and pay Rs 15,000 on account of deficiency in service and causing mental and physical harassment, along with Rs 10,000 as cost of litigation.
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