AI Overview...
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Claim repudiation for experimental treatments - Insurance companies often deny claims citing treatments as unproven or experimental, leading to deficiency in service findings by consumer forums and courts. For example, in NEW INDIA ASSURANCE COMPANY LIMITED VS ISHU MOTWANI - Consumer, the court held that repudiating a claim based solely on similarity to another treatment without expert evidence constitutes deficiency. Similarly, in NATIONAL INSURANCE COMPANY LIMITED VS SH. MAHESH PANT - Uttarakhand, the treatment (Ozone Discolisis) was deemed an approved procedure under policy, and its rejection was found unjustified. United India Insurance Company Limited VS Jai Parkash Tayal - Delhi highlights that claims for naturopathy, acupressure, acupuncture, magnetic therapies, and other unproven treatments were rejected, but courts have scrutinized such denials, especially when treatments are recognized or approved.
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Legal and procedural issues - Many cases involve procedural lapses, such as lack of prior intimation or delays, which courts sometimes consider mitigating factors. For instance, BRESTU RAM VS ANANT RAM - Himachal Pradesh discusses a delayed claim filed after over four years, with the tribunal rejecting it on limitation grounds. Conversely, some courts have found repudiations unjustified if the treatment is recognized or the claim is not properly substantiated, as in NATIONAL INSURANCE COMPANY LIMITED VS SH. MAHESH PANT - Uttarakhand.
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Experimental and unproven treatments - Several sources mention treatments labeled as experimental or unproven, which insurers often reject. However, courts have emphasized the importance of evidence and policy terms. In Jyothy Laboratories Ltd. VS State of Assam through its Principal Secretary, Finance Department, The Commissioner of Taxes and The Superintendent of Taxes - Gauhati, a claim involving a treatment identified as an alter ego was rejected, but the emphasis was on expert analysis and classification.
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Impact of policy clauses and treatment recognition - The acceptance or rejection of claims often hinges on whether the treatment is recognized under the policy. NATIONAL INSURANCE COMPANY LIMITED VS SH. MAHESH PANT - Uttarakhand notes that ozone discolisis was an approved treatment, making its rejection unjustified. Similarly, the inclusion of certain therapies under policy clauses influences claim outcomes.
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Other contexts of repudiation - Some sources relate to repudiation in employment and municipal contexts (PIMPRI CHINCHWAD MUNICIPAL CORPORATION vs RAVI ARJUN JAGTE AND ORS - Bombay, Pimpri Chinchwad Municipal Corporation Through its Municipal Commissioner, PCMC VS Ravi Arjun Jagte, Yamuna Nagar, Nigdi, Pune - Bombay, PIMPRI CHINCHWAD MUNICIPAL CORPORATION AND ORS vs RAVI ARJUN JAGTE AND ORS - Bombay), illustrating that repudiation issues extend beyond insurance claims to contractual and statutory relationships, often with similar themes of dispute over experimental or contractual status.
Analysis and Conclusion:
Claims for experimental or unproven treatments are frequently repudiated by insurers citing policy exclusions or treatment status. However, courts tend to scrutinize such denials, especially when treatments are recognized, approved, or supported by expert evidence. Procedural lapses like lack of prior notice or delays can influence outcomes but do not automatically justify repudiation. Overall, the legitimacy of repudiating claims for experimental treatments depends heavily on policy terms, treatment recognition, and procedural fairness.
Search Results for "Claim to be Repudiated for Experimental Treatments"
• India - Consumer
B.C.GUPTA, M.SHREESHA
Case: The complainant underwent SPMF Therapy for knee pain, which was repudiated by the insurance company under the exclusion ... that repudiating the claim on the ground of similarity to a different treatment without expert evidence amounted to deficiency of ... Ratio Decidendi: The court found that repudiating the claim based on similarity to a different treatment without expert evidence ... The Opposite Parties repudiated the claim vide letter dated 27.02.2013 on....
2013 0 Supreme(UK) 83 • India - Uttarakhand
B.C.Kandpal, C.C.Pant, Kusumlata Sharma
- Thus, District Forum rightly found opposite parties to be guilty of deficiency in service by repudiating the claim of the complainant ... (A) Consumer Complaint - Non payment of mediclaim expenses - Deficiency in service - Insurance company submitted that the treatment ... taken by the complainant was under the category of "unproven procedure" - Held that Ozone Discolisis was an approved treatment in ... 4.13 of the policy and, as such, the claim was not payable and was rightly repudiated on 27.12.201....
2011 0 Supreme(Gau) 214 • India - Gauhati
AMITAVA ROY
Debnath argued that judged by the consistent experimental analysis ,Ujala Supreme is an alter ego of AVP in a diluted form and thus being distinctly identified by HSN Code No. 3204 12 94 ,the finding to the contrary as recorded in M.P. ... Its claim, however, was rejected by the order dated 2.8.07, whereupon it preferred an appeal with the Deputy Commissioner of Taxes (Appeals), Guwahati. ... Ed. 336-338 was referred to with approval ... Manufacture implies change, but every change is not manufacture and yet every change of an article is the result of #HL_....
2018 0 Supreme(Del) 518 • India - Delhi
PRATHIBA M.SINGH
for the same medical condition, and for which his claim was sanctioned - No advance intimation was given to the Plaintiff about ... on any tests conducted on him - It was a clause suddenly inserted in the year 2011, prior to which the Plaintiff had undergone treatment ... ... 4.15 Naturopathy Treatment, acupressure, acupuncture, magnetic therapies, experimental and unproven treatments/therapies. ... The said claim was rejected vide letter dated 6th February, 2012 where the reasons for....
1989 0 Supreme(HP) 106 • India - Himachal Pradesh
BHAWANI SINGH
The Tribunal rejected the claim on the ground of limitation. ... Whether the delay in filing the claim petition was justified and should be condoned? 2. ... The claim petition was filed after 4 years and 4 months due to the claimant's serious injuries, hospitalization, ignorance, poverty ... The respondents have repudiated the claim of the claimant and it has been denied that the accident took place due to rash and negligent driving by respondent No. 2 on the date, place and time mentioned in the petiti....
2024 Supreme(Online)(Bom) 1322 • India - High Court of Bombay
HON'BLE SHRI JUSTICE SANDEEP V. MARNE
By this process, workmen repudiate their relationship with the contractor under whom they are employed but claim relationship of an employee under the appellant. ... He would submit that contracts were awarded to various persons for door-to-door collection of garbage through push-carts with a view to implement the cleanliness drive undertaken by the Petitioner-PCMC on experimental basis. ... That the Municipal Solid Waste Rules were implemented much later in the year 2016 and that therefore resolutions adopted Standing Committee of the Pe....
2017 0 Supreme(UK) 2 • India - Uttarakhand
RAJIV SHARMA, SUDHANSHU DHULIA
Initially this concession should be tried on an experimental basis. In due course, and after having gained enough experience, it may be further developed to suit local conditions in each State. The State Government should issue detailed instructions in the respect. ... 23.22. ... ... We see no reason why the right to be visited under reasonable restrictions, should not claim current constitutional status. ... The ward-warden relationship needs holistic repair if prisons are, in Gandhian terms, to become hospitals, if penology, as modern criminologists #HL....
2021 0 Supreme(SC) 259 • India - Supreme Court
Motor Vehicles Act,1988 – Sections 166 and 185 – Accident claim ... The appellant repudiated the claim by the respondent. ... This was an experimental study where 75 male volunteer drivers were administered ethanol beverages sufficient to produce BACs of either zero or between 0.05 and 0.15%. Consumption was spaced over a 1.5-2h period. ... the above said claim. ... We are in this case not dealing with a third-party claim. ... For the exception to apply it is not enough to show that th....
2024 0 Supreme(Bom) 677 • India - Bombay
SANDEEP V. MARNE
By this process, workmen repudiate their relationship with the contractor under whom they are employed but claim relationship of an employee under the appellant. ... He would submit that contracts were awarded to various persons for door-to-door collection of garbage through push-carts with a view to implement the cleanliness drive undertaken by the Petitioner-PCMC on experimental basis. ... That the Municipal Solid Waste Rules were implemented much later in the year 2016 and that therefore resolutions adopted Standing Committee of the Pe....
2024 Supreme(Online)(Bom) 1324 • India - High Court of Bombay
SANDEEP V. MARNE, J
By this process, workmen repudiate their relationship with the contractor under whom they are employed but claim relationship of an employee under the appellant. ... He would submit that contracts were awarded to various persons for door-to-door collection of garbage through push-carts with a view to implement the cleanliness drive undertaken by the Petitioner-PCMC on experimental basis. ... That the Municipal Solid Waste Rules were implemented much later in the year 2016 and that therefore resolutions adopted Standing Committee of the Pe....
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