Consumer Affairs Ministry to Address Concerns on Denial of Medical Claims

In response to a critical issue raised by the National Consumer Commission chief, the consumer affairs ministry has pledged to address the matter with the Insurance Regulatory and Development Authority of India (IRDAI) and the Department of Financial Services (DFS), according to a recent report by The Times of India.

The focal point of concern revolves around the denial of medical claims by insurance companies if a policyholder is not hospitalized for a minimum of 24 hours for surgery or treatment. Justice Amreshwar Prasap Sahi, the president of the National Consumer Disputes Redressal Commission (NCDRC), stressed the necessity of reassessing this clause. He highlighted the changing landscape of medical procedures, where advancements now allow for treatments and surgeries to be completed within a few hours.

Justice Sahi pointed out that some district forums have already taken innovative measures by ordering that claims must be paid even if the hospitalization is 23-and-a-half hours, citing the rapid pace of modern medical treatments.

Union Consumer Affairs Secretary Rohit Kumar Singh affirmed the ministry’s dedication to consumer interests and expressed the intention to collaborate with IRDAI and DFS to find a viable solution. Singh emphasized, “In the interest of consumers, we will take it up with IRDA and DFS to find a way out.”

While acknowledging improvements in complaint resolution efficiency, Justice Sahi raised concerns about the challenges in executing these orders. He underscored the need for a standardized scheme for execution to enhance the effectiveness of consumer justice. The ministry’s focus is on finding solutions and reducing disputes to ensure a more consumer-friendly insurance sector.