Vadodara: The number of uniforms for cataract surgery cannot be assumed or determined by an insurance company while dealing with claims of insured people, the court here ruled last week.
Consumer Disputes Regency Vadodara Redressal Forum rejects the Claims of Oriental Insurance Company Ltd.
and Third Party Administrators MD India Health Insurance TPA Pvt Ltd that RS 24,000 is a reasonable amount for cataract surgery in one eye.
The Forum was hearing complaints submitted by residents of Harni WaraAsia Ring Road, Dr.
TJ Prajapati, who had undergone cataract surgery for his left eye in November 2019.
Prajapati raised 42,000 Rs costs for operations, but insurance companies and insurance companies and landfill were paid only RS 24,000.
The court stated that ophthalmologists used imported lenses and expensive ingredients to ensure that cataract surgery was carried out correctly so that the eyes and visual patients remained healthy.
“In such circumstances, operating costs may be more.
It all depends on which experts do the operation and use the type of lens and no conditions in the policy that certain types of lens can only be used,” the forum stated in the assessment.
During hearing, the opposing lawyer submitted that the remaining RS 18,000 was deducted according to the policest cataract limit.
It is said that in accordance with the insurance company policy RS 24,000 can only be considered as a reasonable and customary cost for cataract operations and 42,000 Rs costs incurred by excessive prafati.
Opposed the insurance company and landfill argument, Prajapati’s lawyer told the court that the money was reduced incorrectly because Prajapati was never notified where the policy clause made or clause was stated in the policy he had purchased in 2010.
The attention of the court was also interested in facts That the TPA has reduced the number and insurance company not writing a letter to Prajapati which tells her that money has been deducted and under the clause.
The court upholds the argument and also continues to note that insurance companies and landfill cannot support their claims that RS 24,000 is a reasonable amount by sending doctors who are experts.
The number of claims for cataract surgery cannot be improved: Vadodara court
