Insurance claim even for death after refusing treatment: High Court

CHANDIGARH: 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'.

It is an important development since many insurance companies tend to use Leave Against Medical Advice (LAMA) as an excuse to deny the family of the deceased their claims, say medical experts.

The judgment comes in a case where the 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 favour of the family of the deceased.

“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 or der 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.

The court passed these orders while dismissing an appeal by Oriental Insurance Company, which had stated that a family of an insured person leaving treatment against medical advice was not entitled for a claim after death.

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.