MTP to save pregnant woman’s life covered by insurance: Consumer Forum

According to the order, Gowri, who was pregnant with twins, visited Kauvery Hospital, Chennai, in her 23rd week of pregnancy in a critical condition.
Image used for representational purposes only(File | EPS)
Image used for representational purposes only(File | EPS)

BENGALURU: A consumer disputes redressal forum's ruling that an insurance company cannot reject medical insurance for a pregnant woman who has undergone Medical Termination of Pregnancy (MTP) when there is a threat to her life, has helped a city resident win her case.

Based on this, Bangalore Urban District Consumer Disputes Redressal Forum, comprising president Shankara Gowda L Patil and Member P K Shantha, ordered ICICI Lombard General Insurance to pay medical expenses with compensation and litigation cost to the complainant, Jaya Gowri Balachandran, residing at Garebhavi Palya in the city.

Gowri, who was working with a private company, had sought a portion of the claim, but this was disallowed as policy excess of Rs 97,028 by the insurance company.

“The Opposite Parties, including ICICI Lombard General Insurance, are jointly liable to pay medical expenses of Rs 97,028 to Jaya Gowri. In order to meet the ends of justice, it was asked to pay compensation of Rs 5,000 for causing mental agony and hardship undergone and litigation cost of Rs 3,000 to Gowri," the Forum ordered.

According to the order, Gowri, who was pregnant with twins, visited Kauvery Hospital, Chennai, in her 23rd week of pregnancy in a critical condition. The consultant doctor examined her and observed that she suffered severe pre-eclampsia and acute renal failure. Considering her condition, she was immediately admitted to the ICU. On July 9, 2013, her symptoms worsened and her attenders were informed that unless an MTP was done, her chances of survival were slim.

Gowri’s family members consented for an MTP, which was planned and done with Misoprostol, and both the fetuses were expelled on July 10, 2013.Taking note of the circumstances, the Forum said: “In the strict sense, childbirth did not indicate it is a living child or born dead. In this case, both gestations were expelled. It is settled proposition of law that a child in the mother’s womb is entitled to all types of rights, including right to property.

Hence, the claim repudiated by ICICI Lombard General Insurance has no leg to stand on, in the light of decisions of various judgments of consumer forums that insurance companies cannot be allowed to escape liability on technical grounds, to deprive the consumer of benefits to which he/she is entitled. Hence, the insurance claim must be honestly settled without any delay."  

The Forum also stressed that the definition of Maternity Expenses Benefit means treatment taken in hospital/nursing home arising from or traceable to pregnancy and childbirth, including normal and Caesarean section.

ICICI Lombard General Insurance contended that the complainant's claim is related to maternity benefit. It further submitted that the complainant had undergone abortion, but the insurance policy does not cover claim for abortion (MTP). Under maternity benefit, Rs 40,000 was already paid, and the complainant was not entitled to any further claim, the insurance company said while accusing Gowri of suppressing facts and not come with clean hands.

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