BENGALURU: A senior citizen recently sued a medical insurance company for rejecting her claim towards knee treatment at a Bengaluru clinic. After a two-year legal battle, a consumer court ordered the firm to grant her the full amount of nearly Rs 1.3 lakh and a compensation of Rs 20,000.
A native of Andhra Pradesh, Gayatri Venkateswaralu, 60, was suffering from severe osteoarthritis. With walking and regular work becoming difficult, she contacted SBF Healthcare and Research Centre where veteran radiologist Dr V G Vasishta offers treatment with his researched methods.
Row over procedure
In July 2018, Gayatri underwent sequentially programmed magnetic field (SPMF) therapy and experienced great relief on her legs. Holding an active Medi-classic Insurance Policy of Star Health and Allied Insurance Company Limited for which she paid dues since 2009, Gayatri submitted her claim for a bill of Rs 1.3 lakh. But it was denied on August 1, 2018.
The elderly woman and her husband tried to reason with insurance officials about the treatment of Kannada Rajyotsava award-winning doctor VG Vasishta who is famous for his SPMF. However, insurance officials stood their ground stating the therapy doesn’t attract rightful mediclaim. With all hope lost, Gayatri approached Bangalore IVth Additional District Consumer Disputes Redressal Commission in Shantinagar on February 21, 2019.
During the litigation that lasted for close to 28 months, Gayatri’s lawyer presented her case while the company’s attorney claimed they rightfully denied the claim. He stated the clauses were explained to the policy holder in advance and expenses incurred on the enhanced external counter-pulsation therapy, rotational field quantum magnetic resonance therapy and similar procedures were not included.
However, the judges cited a similar case of SPMF treatment where a medical insurance claim was granted to the customer and said denying the amount to the elderly woman was unjustified. On June 14, 2021, the court asked the firm to give Gayatri Rs 1.25 lakh with interest, apart from Rs 10,000 as compensation and Rs 10,000 towards her court expenses.
