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Maternity benefits not applicable only to live births

The Pune consumer forum has slammed a private insurance company for denying maternity benefits to a woman who had to abort her 23-week twin foetuses due to medical complications. After a five-year battle by the victim, the court rapped the firm for acting unjustly and ordered full payment and compensation.

Radha (name changed), an employee of Wipro, was suffering from severe preeclampsia and could slip into a coma triggered by hypertension and acute renal failure, and hence had to undergo an abortion. With consent from the family, doctors performed the procedure. She had to pay a hospital fee of over Rs 1.5 lakh. An ICICI Lombard General Insurance policyholder, Radha submitted the bills to claim refund through the agent Medi Assist India. Much to her disbelief, the insurance company paid only Rs 24,313 and disallowed Rs 97,028, terming it ‘policy excess.’

The company told Radha that maternity benefits were applicable only to two live births, and that she was not admitted to the hospital for delivering babies and also that her condition was failure of other organs. Further, the company said that she was treated to save her life and it was for this reason the pregnancy was terminated.

The consumer forum came down heavily on the insurance company, stating childbirth does not indicate living or dead child, and asked the company to not just settle the claim but also compensate the victim.

Divya Patwal

VOICE

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