It stated that the company’s initial permission and later refusal amounted to inconsistent behaviour. United India Insurance Co Ltd will now have to pay the Maladwalas treatment cost of Rs 4.8 lakh, along with a compensation of around Rs 1 lakh.
The consumer forum pronounced two orders and did not accept the insurance company’s reasoning that naturopathy treatment, acupressure, acupuncture, magnetic therapies, experimental and unproven treatment therapies, including drug experimental therapy which are not based on established medical practices in India, are not payable.
“The insurance company failed to prove that how treatment taken by the complainant was unproven. It is pertinent to note that after taking the treatment the complainant healed from her pain of knees,” the forum said in Dilshad’s case.
The two complaints were submitted before South Mumbai District Consumer Disputes Redressal Forum in June 2016. Both told the forum that they had pain in knee joints and that they had taken medicines from their family doctor, but only got temporary relief. Soon, they learnt about SPMF being offered by a Bangalore company, which had a centre in the city.
The couple told the insurance company that on December 28, 2013, they were told treatment would commence the following day. They stated that it would last for 21 consecutive days. The treatment went on until January 18, 2014, with no breaks on Sunday and holidays. They filed their claims. In June 2014, the insurance company repudiated it.
The Maladwalas told the forum that the refusal was baseless, illegal and extremely discriminatory. “As SPMF treatment is proven technology and standard treatment accepted worldwide. It has proven to be effective and provides huge relief to patients, eliminating the need for knee replacement surgery, and it does not necessitate hospitalization,” they claimed.
The forum ruled in favour of the complainants. “The opposite parties (insurance company and Health India TPA Services Pvt Ltd) have committed negligence in repudiation of the complainants’ claim in addition kept deficiency in service and unfair trade practice towards the complainant,” the forum said.