Patient autonomy priority! Insurance claim for ‘leave against medical advice’ patients

Insurance companies are the first to hand out policies, but come up with a number of valid ‘excuses’ when they have to hand over the claim money. Panjab and Haryana High Court has passed a verdict that insurance companies, now, cannot deny claim amount to family of a patient who has been declared as terminally ill, even if the patient decides to stop medical treatment against the advice of the medical fraternity.

The High Court has stated that the family of the patient who is terminally ill, will get insurance claim benefits even if the patient decides to discontinue treatment against the advice of the doctors and then dies.

The High court has clarified that the decision of refusing or not taking adequate treatment is the patient’s prerogative and this is based on the fact of “patient autonomy” and “embarrassing dignity in death”.

Many insurance companies in the past have denied medical claims to the family of patients by quoting “Leave against medical advice” as the excuse to deny the claim to the family.

The recent decision is a result of denial of an insurance claim of Rs 35.46 lakhs to a family of 56 year old R.K. Dogra, a bank employee from Chandigarh, who had sustained serious head injuries in a road collision on 15th Mar, 2013. The patient was sent back after 4 days but had to return to the hospital because his condition had deteriorated and the reason was stated to be “right temporoparietal bleed with midline shift”.

He had requested to be released from hospital when the medical fraternity did not see hope of his recovery. So against doctors’ advice, he had asked for a discharge on May 7th in a bad condition. The insurance company refused to hand over the claim money on the basis of “LAMA”. The case was taken to court and the family of the deceased won the plea.

Justice K. Kannan handling the situation said that patient autonomy was a human right and “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.”