A consumer court has hauled up the New India Assurance Company Ltd for refusing to reimburse the cost of a life-saving equipment to a claimant, who purchased it to overcome his sleep disorder, on the ground that it did not come within the purview of his policy.
"Sleep disorder if not treated early may be life-threatening. The company's claim that the equipment 'Continuous Positive Airway Pressure' (CPAP) machine, a life-saving device like the pacemaker, does not come under the purview of the claim is not true," Consumer Disputes Redressal Forum (north), headed by K K Chopra observed.
The court ordered the company to pay Rs 56,160 as full reimbursement of the cost of the equipment besides a compensation of Rs 9,000.
Rakesh Kumar Juneja, a resident of Tilak Nagar in New Delhi, started having restless nights during which, according to his wife, his sleep was interjected with 'loud snoring followed by a period of silence and then a loud gasp as he started breathing again.'
The disturbed nights also caused irritability, memory lapse, morning headaches and even acute depression.
After consultations with a specialist at Safdarjung Hospital and various tests, he was diagnosed with obstructive sleep apnea syndrome and recommended nasal CPAP for proper control of his illness.
Banking on a one-year medical insurance policy he had taken a few months before the start of his ailment, Rakesh bought the CPAP device for Rs 56,160 and later applied for a reimbursement.
The company refused payment on the ground that sleep disorder was a 'chronic phenomenon' and does not develop within months of taking the policy. Again, the CPAP was an 'external device,' unlike pacemakers, and could be used by persons other than the insured.
Moreover, the company argued that the expense of the device would not be covered in the first year of the policy.
Dismissing the company's contentions, the court held that CPAP machines were in the same category as pacemakers, artificial limbs, etc and their costs should be covered in the policy.
"The device is the only solution to the complainant's problem and the company is liable to pay him its purchase price," the court said.
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