Mediclaim valid in ectopic pregnancy

Insurance Companies generally repudiate any delivery-related claims in the first year of the mediclaim policy, reports Harish V Nair.

Insurance Companies generally repudiate any delivery-related claims in the first year of the mediclaim policy. A new rule, however, says they cannot reject claims of ‘ectopic pregnancy’ during this period, which results either in a stillborn baby or the mother’s death.

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The State Consumer Disputes Redressal Commission in a benchmark judgment differentiated ectopic pregnancy from ordinary pregnancy and ruled that insurance companies were bound to reimburse the expenses incurred by policyholders, even during the first year of the policy. “Merely because the word ‘pregnancy’ is co-joined with it, ectopic pregnancy cannot be categorised as an ordinary pregnancy,” held Commission President (Justice) JD Kapoor.

Justice Kapoor gave the ruling while directing the Oriental Insurance Company to pay the entire bill amount of Rs 55,556.45 and a compensation worth Rs 10,000 to Laure Brar, whose claim, the judge said, was “illegally repudiated” by “wrongly invoking” the exclusion clause in the policy.

Laure took a mediclaim policy from the company for a year on November 21, 1995.