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Life-saving machines and devices such as pacemaker, CPAP, BiPAP, orthopedic implants, intracardiac valve replacements, vascular stents, relevant laboratory diagnostic tests, X-ray and such similar implants and machines are often prescribed by registered medical practitioners to their patients.
Such machines are duly covered under the insurance policy / Mediclaim policy.
If any patient is advised to use CPAP machine for his treatment and such patient has an insurance policy / Mediclaim policy in his/her name, then the insurance company has to make the payment of the cost of CPAP machine to such patient as the same is covered by the insurance policy. Even if there is no specific clause in insurance policy / mediclaim policy stating that the CPAP machine is covered under the insurance policy, then also the insurance company has to pay the patient for the cost of CPAP machine as the same is life-saving machine and without it the treatment of the patient is not complete.
All the doctors, registered medical practitioners, hospitals, nursing homes, etc. should educate their patient that the CPAP machine being a life-saving machine is duly covered by the insurance policy/Mediclaim policy obtained by them and they should immediately contact their insurance company for claiming the reimbursement of the cost of the said machine.
In numerous cases, the National Consumer Dispute Redressal Commission and State Consumer Dispute Redressal Commission of Delhi have held that the CPAP machine being a life-saving machine is completely covered by the insurance policy and the claim of the patient for the same has to be paid by the insurance company.
- “New India Assurance Co. Ltd. versus Ghanshyamdas A. Thakur,” order and judgment dated 07.02.2014 passed by Hon’ble National Consumer Disputes Redressal Commission
- Narender Kumar Jain versus United India Insurance Company Limited, Hon’ble State Consumer Dispute Redressal Commission of Delhi
“The New India Assurance Co. Ltd. & Anr. Versus Mrs. Sonali Sareen & Anr.” Delhi State Consumer Disputes Redressal Commission order dated 09.12.2014