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The court upheld the argument that the copy of terms and conditions was never given to Bhatt, but also drew attention that it cannot be assumed that anaemic condition was due to nutritional deficiency or by not having proper food.
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Bhatt, in his complaint, had told the court that the insurance company never gave him a copy of the policy’s terms and conditions. Bhatt was admitted to a private hospital in Nizampura for five days in May 2015 for problems related to his condition. The insurance firm had also stated that anaemia is a nutritional deficiency in the claim rejection letter. Bhatt had approached consumer court in August 2015 as the third-party administrator on behalf of the insurance company had rejected his claim stating that treatment related to nutritional deficiency is not payable as per the terms and conditions of the health insurance policy. The court recently ordered National Insurance Company Ltd to pay the treatment expenses amounting to Rs 33,820 to the complainant Ashish Bhatt along with 9% interest and a compensation of Rs 10,000, as the insurance company could not substantiate its claim that Bhatt’s condition was due to nutritional deficiency. VADODARA: Weakness and body ache due to anaemia cannot be seen as a rundown condition or cause of nutritional deficiency, ruled a consumer court here.