The National Consumer Commission has held that in cases where there is conflict of opinion between two medical experts over a point, credence should be given to the doctor who had actually treated the patient.
The Commission passed the order on a petition filed by one Durga Devi challenging the decision of Madhya Pradesh State Commission which had rejected her insurance claim of Rs five lakhs on the basis of conflicting medical opinion.
"It is a fact that there is varying medical opinion of two specialists on file. In such a situation we are of the view that more credence must be given to the opinion and the conclusion of the medical expert who had actually treated the patient and therefore has first-hand knowledge about the case," the Commission bench comprising Justice Ashok Bhan and Member Vineeta Rai said.
Devi had obtained a personal policy from the National Insurance Company which promised to indemnify her to a tune of Rs five lakh in case of any injury or death resulting from an accident. She claimed the insurance amount after accidentally falling in bathroom and the resulting paralysis that led to 100 per cent disability in the right side of her body.
The insurance company opposed the petition on the ground that Devi's accidental fall was due to a pre-existing disease and was therefore, not covered by the insurance policy. Rejecting the plea of the insurance company, the apex consumer body restored the order of the District fora which had allowed her claim.
"We conclude that the insurance claim was wrongly repudiated by the respondent. Revision petition is therefore, allowed. We set aside the impugned order of the State Commission and restore the order of the District Forum in toto," the bench said.