Respected Sir's
I have query to ask on "medi-claim repudiation" on following grounds (as mentioned on the letter):
"Our medical team has observed from the investigation reports and hospital records including the discharge
summary that the insured-patient had received the treatment under allopathic medicinal system given by a
non allopathic doctor.
As per the terms and conditions of the policy the company is not liable to make any payments under this
policy in respect of any expenses incurred by the insured person, for the treatment of disease /illness
/accidental injuries under allopathic medicine system given by a non allopathic medical practitioner.
We therefore regret our inability to admit your claim under the above policy and we hereby repudiate your
claim."
The treatment taken is from a registered B.A.M.S. Doctor.
I would like to know that if a B.A.M.S doctor is not qualified to practice the "Allopathic Medicinal Treatment"?
I tried to find a valid reason of repudiation with the help of the Section 2 (1) of the Indian Medicine Central Council Act. 1970 (48 of 1970) to which the medi-claim representative mentioned that under “The Terms & Conditions” of their medical insurance the B.A.M.S is not a "Medical Practitioner" as per their terms and conditions.
On top of that he got upset on me getting a printout of the “Notification Section 2 (1) of the Indian Medicine Central Council Act. 1970 (48 of 1970)” and pointed out to for the clarification of the following statement “Further it is clarified that the rights of practitioners of Indian Systems of Medicine to practice modern scientific system of Medicine (Allopathic Medicine) are protected under Section 17(3) of I.M.C.C.Act. 1970.”
Require legal advice on if the above repudiation valid.
I thank you in advance for your support.
Regards,
Rohit
