The Madras High Court directed United India Insurance Company to reimburse the treatment expenses of Rs44,581.00 with 9% interest to a petitioner, S Dhanalakshmi, who got her baby admitted to a non-network hospital due to an emergency. The petitioner had joined the health insurance scheme in 2012 and was subscribing to it regularly.
Justice R Subbiah said that the HC had already advised that a person’s claim should be considered on the satisfactory reason that they were unable to get treated in a network hospital, but had been advised to go to a non-network hospital.
In this case, Ms Dhanalakshmi’s son had vomited and she was under the impression it was just food poisoning. But his condition worsened and she had taken the child to a nearby hospital, where doctors diagnosed it as obstructed hernia and recommended that he should be operated immediately. On their advice, her son had undergone emergency surgery.
The petitioner had obtained the necessary certification, of being a genuine case, from the state health authorities. Hence, the insurance firm could not reject her claim on the ground that treatment was done in a non-network hospital, the judge said.