The Andhra Pradesh State Consumer Redressal Commission has asked doctors and hospitals to not share patient information unless required by a court of law, and warned of possible legal consequences if they go against this. The Commission was dealing with a home-loan case against SBI. The Commission stated that maintaining confidentiality of a patient’s medical aspects was absolutely necessary and stressed that it was not only part of a doctor’s professional conduct but also a Constitutional obligation.
A two-member bench comprising Justice Noushad Ali (president) and P Mutyala Naidu of the commission were allowing the claim of one G Vijaya Kumari of Vijayawada against SBI Life Insurance Company Ltd. The bench observed that “it is trite to note that of late, almost every doctor/hospital is observing a professional obligation and the mandate of Constitution with impunity. They are sharing medical records of patients routinely with insurance companies, without realising consequences.”
“While selling the policies, the insurance companies do not take care as to whether the intending purchaser is eligible for the policy. They in fact lure them through agents and sell policies only with a view to improve their financial top-line. But when it comes to settlement of claims, they engage in all sorts of exercises, suspecting bona fides of claim,” the bench noted. The bench pointed out that the insurance companies invariably engaged their so-called investigators, who in-turn approached doctors/hospitals for records.
The commission said that doctors/hospitals should treat medical records and patient information as highly private and sensitive, to maintain doctor-patient confidentiality, and should adhere to regulations of Indian Medical Council of India.
The case of the applicant was that her husband Seshagiri Rao had obtained Rs 22 lakh as housing loan from SBI Branch at Benz Circle in Vijayawada. The insured covered the loan with a policy under SBI RIN Raksha Home Loan Scheme, by paying a premium of Rs 64,057. The policy was valid for a period of 186 months, with insurance cover from 14 September 2012, and the bank was the master policyholder. Seshagiri Rao died in 2014 due to cancer and when his wife approached the bank claiming waiver of the home loan covered by the insurance policy, the bank denied the claim on the ground of suppressing facts, based on a report given by an investigator engaged by SBI Insurance Ltd.
The commission noted that the insured on his part appeared before a panel, including a doctor of the bank, who had then issued a certificate about his good health, and so the claim of the bank and insurance company on the ground of suppression of material facts by the insured of his pre-existing illness did not have any substantial legal proof. While holding that the applicant was liable for the claim, the commission directed SBI to settle the claim and refund the property documents as well as pay Rs 1 lakh to the applicant as compensation towards mental agony, and also directed the bank to pay Rs 25,000 towards cost of litigation, within three months.