A consumer forum has said Rotational Field Quantum Magnetic Resonance (RFQMR), a non-invasive osteoarthritis treatment, could not be called an alternative or experimental therapy and ordered an insurance firm to pay up for rejecting two claims.
Dismissing New India Assurance Co's argument that the treatment was not recognized by the Indian Medical Council, the forum asked it to pay first complainant Sanyuktaben Shah the insured amount of Rs 1.05 lakh with a compensation of about Rs 46,000, and second complainant Bhisham Lambh Rs 1.30 lakh with a compensation of Rs 40,000.
The forum held that the insurance company had not produced any evidence to show that RFQMR was not recognized by the Indian Medical Council. "Only mentioning the same in the mediclaim policy clause would not be held just and proper for repudiating the claim," it said.
Vile Parle resident Sanyuktaben Shah, in her complaint on 2010, said she came to know about RFQMR about five years ago when osteoarthritis attacked her knee joints. She took the treatment at a Bangalore-based company's Andheri centre in 2008 and was in regular consultation with doctors and physiotherapists as there was still some pain. She also visited a health care centre and was recommended some oral medicines which worked. That year in December, she submitted a claim for Rs 1.05 lakh, which was repudiated.
Juhu's Bhisham Lambh also underwent the treatment after crippling pain in his knees from December 2009. After the 21-day therapy in May 2010, he sent the insurance company a claim of Rs 1.30 lakh. A month later, it was rejected. He moved the South Mumbai District Consumer Disputes Redressal Forum in October 2010.
In both cases, the insurance company said the treatment was experimental and unproven and, therefore, according to the terms and conditions of the mediclaim policy, they were rejected. It stuck to its stand in the forum.
The forum ruled otherwise after taking into consideration the literature produced by the complainants. It showed that RFQMR significantly decreases pain, increases mobility, stability and power of the knee joint, and increases cartilage thickness in osteoarthritis patients. "Furthermore, as per the documents of objectives of Indian Medical Council which is placed on record by the complainant, it appears that the council does not have any object to approve any specific treatment or disapprove any treatment," the forum said.
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