Mumbai: Commission Reprimands Insurance Company For Rejecting Claim In Medical Emergency Abortion Case

Mumbai: The South Mumbai District Consumer Dispute Redressal Commission has reprimanded the national insurance company for its conduct and intentions to avoid the liability of an insurance claim in reimbursing the medical bills of a 31-year-old woman who had to abort her 26-week-old pregnancy under medical emergency.

The commission observed that there was no strong documentary evidence filed by the insurance company to show that the said process was an abortion or voluntary termination of pregnancy. Thus holding the insurance company guilty of arbitrarily rejecting the medical claim, the commission, has directed the firm to pay the entire medical expense incurred by the Matunga-based family of Rs 1,72,934 along with six percent interest on the amount from 2018.

The commission has also directed the company to pay an additional amount of Rs 25,000 along with Rs 10,000 towards the complainant’s mental agony and litigation charges.

Dhruv Acharya, a resident of Matunga, had approached the commission and filed a case against the insurance forum. Acharya said in his application that, on June 25, 2017, he had to admit her to H.N. Reliance Hospital as she experienced some serious issues in her pregnancy.

The doctors, after examining his wife, advised them to have an abortion since the 24-week-old fetus was not moving. Also, the sonography was not able to trace the heartbeat of the fetus.

However, after the abortion, a claim was submitted before the insurance company, but the company rejected the claim on the grounds that the abortion was done voluntarily.

The commission, however, came down heavily on the insurance company. The commission, in its orders, observed, “The very purpose of bringing this information on record is to understand the complexity in such cases. The wife of the complainant has undergone this trauma. Thus, the above procedure done with the wife of the complainant is not their choice to deny the birth of a baby. The conditions of the fetus observed during sonography, which ultimately can be confirmed from the discharge summary, indicate that the procedure done with the complainant's wife was very much required to avoid further health complications. Thus, it can be confirmed that there was no voluntary termination of pregnancy or anything traceable to pregnancy. As there was no chance left of normal delivery and there was no movement of the fetus and no abdominal pain, the operating doctor had to abort the dead fetus.”