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Maternity benefits not just for live births, says consumer court
The Economic Times, December 07, 2018


Bengaluru: A private insurance company’s contention that maternity benefits are applicable only to live births came under criticism from a city consumer court recently. The judges slammed the firm’s decision to deny a Bengaluru techie her policy claim after she had to abort her 23-week twin foetuses.

After a five-year battle by the victim, the court rapped the firm for acting unjustly and ordered full payment and compensation.

Maya (name changed), an employee of Wipro, was 23 weeks pregnant with twins in July 2013 when she went to a Chennai hospital for a check-up. Doctors established she was suffering from severe pre-eclampsia (a pregnant woman could slip into a coma triggered by hypertension) and acute renal failure. With her condition worsening, on July 9, 2013, doctors informed Maya’s family that only a medical termination of pregnancy and removal of foetuses could save her life.

Child in its mother’s womb is entitled to all rights: Court

With consent from the family, doctors performed the procedure.

A heartbroken Maya underwent treatment and was discharged on July 22, 2013 after paying hospital fee of over Rs 1.5 lakh. An ICICI Lombard General Insurance policy holder through Wipro, Maya submitted the bills to claim refund through the agent, Medi Assist India. To her shock, ICICI paid only Rs 24,313 and disallowed Rs 97,028, terming it “policy excess”.

In her complaint to the Bangalore Urban District Consumer Disputes Redressal Forum, Maya said ICICI told her maternity benefits were applicable only to two live births; that she was not admitted to the hospital for delivering babies and her condition was failure of other organs; and that she was treated to save her life and it was for this reason the pregnancy was terminated.

Maya approached the consumer forum on January 29, 2014 against Medi Assist India, ICICI Lombard General Insurance and Wipro.

Medi Assist and Wipro remained ex-parte. ICICI Lombard appeared through its counsel who termed the complaint frivolous, vexatious and an attempt to obtain wrongful monetary gain. The lawyer argued that the complainant was enrolled in a maternity policy and abortions are not covered, even if it is medical termination of pregnancy.

After four years and 10 months, the consumer forum came down heavily on ICICI Lombard, stating childbirth doesn’t indicate living or dead child. It is a settled proposition of law that a child in its mother’s womb is entitled to all rights, including property. Therefore, repudiation of money in this case where foetuses were expelled is unjust, arbitrary and illegal, the judges said. The court on November 17 ruled ICICI Lombard, Medi Assist and Wipro are liable to pay pending medical expenses of Rs 97,028 with a compensation of Rs 5,000 to the woman within four weeks. They were ordered to pay Rs 3,000 towards her court expenses.

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