Vadodara: Treatment given after administering anaesthesia amounts to day care treatment and hence the patient is entitled to receive insurance money, a Vadodara consumer forum observed while hearing a case filed by a resident of Manjalpur in July 2024.Jaiswal stated in his complaint to the forum that he purchased an insurance policy from The Oriental Insurance Company Ltd in 2018 and continued renewing it every year. In 2023, he underwent silicone oil removal surgery in his right eye at a private hospital and was discharged the same day.Jaiswal filed an insurance claim of Rs 36,258, but it was rejected by the insurance company. The firm argued that Jaiswal was not admitted to the hospital for more than 24 hours and therefore it did not qualify as day care treatment.Citing the policy’s terms and conditions, the insurance company said Jaiswal was not eligible for the claim since he was not hospitalised for over 24 hours. The complainant then approached the Vadodara District Consumer Disputes Redressal Commission. “The insurance company said that Jaiswal was not admitted for more than 24 hours and it was not a case of day care either. The company claimed it was an OPD case,” said advocate Ganesh Khopde, who represented Jaiswal.The forum observed that recovery in medical cases is becoming faster due to advances in medical science. In surgical procedures, a patient is administered anaesthesia in the operating theatre, treated, and discharged on the same day to reduce the risk of infection.“It is a surgical process in which one does not have to be hospitalised for 24 hours. But the treatment is done after administering anaesthesia and hence it is included in day care treatment. The insured person has the right to get his claim amount for the treatment expenses,” the forum observed, adding that the claim was wrongfully rejected.“The forum allowed the claim stating that though the patient was not admitted for 24 hours as modern technology enables faster treatment, it was still a day care case and hence the insurance firm should pay the claim amount,” Khopde added.The consumer forum directed the insurance company to pay Rs 36,258 to Jaiswal with 8 per cent interest within two months. The firm was also ordered to pay Rs 2,000 for mental harassment and Rs 1,000 towards litigation costs.
