• Insurance cannot be denied if patient decides to stop treatment against advice: Court

    May 24, 2016

    We have all seen situations where the insurance companies try to run away from the claims made by their clients, citing so-and-so clause of the company rules. In such a case in an insurance company challenged the order of a claims tribunal to pay Rs 35.46 lakh to the family of a deceased who was admitted to hospital after suffering severe head injury in a road accident but decided to leave against doctors' advice when they did not see much chance of recovery.

    The insurance company claimed it was not liable for the damages because the deceased had left the hospital against medical advice. The high court rejected their plea and ruled in favor of the family of the deceased.

    The family of a terminally ill person who decides to stop treatment against medical advice and dies cannot be denied insurance claim, the Punjab and Haryana high court has ruled.

    The high court has also clarified that a patient's desire not to be treated is an issue of `patient autonomy' and `embracing dignity in death'
    This has not been the first of such cases. The instances are in plenty of cases where the insurance companies have used the Leave Against Medical Advise (LAMA) clause as an excuse for declining the insurance claims of the kin of the deceased person.

    “Whether the patient shall be allowed to die by withdrawal of life support is quite different from a patient expressing desire not to be treated. In the former, we are broaching issue of passive euthanasia and in the latter, it is an issue of patient autonomy,“ the bench of Justice K Kannan said in its order that could come as major relief to many such families who are burdened with huge medical costs. Justice Kannan, in his order delivered last week, took the subject to a higher level stating that patient autonomy in the manner of treatment is a facet of human right and it cannot be ever contended in court that the patient ought to have taken treatment that had a good prognosis for recovery.

    “There have been instances where due to religious beliefs (for instance, Jehovah's witnesses' denial of blood transfusion), patients have declined to take treatment and courts have confronted these problems as well and come to decisions of hands-off approach,“ he said.

    In this case, 56-years old R K Dogra, a bank employee from Chandigarh, had suffered head injuries in a road accident on March 15, 2013. On March 19 that year, he was discharged from the hospital in a satisfactory condition but readmitted on May 3 and the summary of treatment recorded from the hospital showed that the problem was diagnosed to be “right temporoparietal bleed with midline shift“.
    The condition of the patient was stated to be bad but he was discharged on May 7 against medical advice. He died the same day.


    The court did a great job in giving out the judgment and in the process of doing so, the court also informed the general public. The court informed the public about the difference between passive euthanasia and issue of “patient autonomy”. While reports have shown that leaving against the medical advice of the hospital or the doctor can prove detrimental to the patient. But the final decision should always be in the hands of the patient. Kudos to the court on handling the case in such a professional and diligent manner. 

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