Case Law Analysis
Clause 5.16 diagnostic exclusion not applicable to invasive electrophysiological study | Consumer Protection Act 2019 - Insurance claim : W.B. SCDRC
The West Bengal State Consumer Disputes Redressal Commission ruled that an electrophysiological study (EPS) is an invasive procedure and therefore falls outside the policy’s diagnostic exclusion clause. It ordered the insurer to pay the cashless claim of Rs 49,119, plus Rs 50,000 compensation and Rs 5,000 costs, signalling that insurers must honour coverage for such invasive diagnostics.