Insurance firm can’t reject claim for reimbursement of medical cost on ground that claimant is diabetic, says consumer commission

Dakshina Kannada Consumer Disputes Redressal Commission asks Bajaj Alliance General Insurance Company Ltd. to pay ₹10,000 as compensation, ₹48,871 treatment cost with 8% interest to a claimant. It was also asked to pay the cost of proceedings

January 28, 2024 08:15 pm | Updated January 29, 2024 10:19 am IST - MANGALURU

The District Commission said that common lifestyle diseases, like diabetes and hypertension, cannot be treated as pre-existing diseases.

The District Commission said that common lifestyle diseases, like diabetes and hypertension, cannot be treated as pre-existing diseases. | Photo Credit: Photo for representation only

Dakshina Kannada Consumer Disputes Redressal Commission has ruled that an insurance firm can’t reject the claim for reimbursement of treatment expenses on the ground that the claimant had diabetes mellitus for long.

Hearing a case, the commission directed Bajaj Alliance General Insurance Company Limited to pay 70-year-old K.S. Rajeeva, a resident of Kulai in Mangaluru taluk, ₹48,872 with 8% interest from February 15, 2023, till realisation of the amount. The insurance firm has also been directed to pay Mr. Rajeeva a sum of ₹10,000 as compensation, and ₹5000 as cost of proceedings.

Mr. Rajeeva had taken a medical insurance policy from Bajaj Alliance and it was valid for the period between November 9, 2022, and November 18, 2023. Mr. Rajeeva was admitted to Omega Hospital in Kankanady following a breathing problem and he underwent treatment for the period between September 30, 2022, and October 2, 2022. He spent ₹48,872 towards treatment. Mr. Rajeeva submitted the claim to the insurance firm for reimbursement of the amount.

On December 9, 2022, the insurance firm rejected the claim on the ground that the claimant had diabetic mellitus for 27 years and it was a known case of diabetes. Contending that he is entitled to claim treatment expenses within the limitation of policy condition, Mr. Rajeeva filed the complaint before the District Commission accusing the insurance firm of deficiency in service and unfair trade practice.

The District Commission comprising of president K. Prakasha and Members P.V. Lingaraju and H.G. Sharadamma, in its judgement dated January 17, 2024, referred to the 2022 decision of Delhi State Consumer Disputes Redressal Commission, wherein it was said that common lifestyle diseases like diabetes and hypertension cannot be treated as pre-existing diseases. And this cannot be grounds for insurance firms to reject the claim, the Delhi Commission stated.

“In view of the above citation, we are of the opinion that the opposite party (insurance firm) is not justified in repudiating the claim of the complainant as pre existing on the ground that the complainant is known case of diabetes mellitus for 27 years,” the District Commission said.

Top News Today

Sign in to unlock member-only benefits!
  • Access 10 free stories every month
  • Save stories to read later
  • Access to comment on every story
  • Sign-up/manage your newsletter subscriptions with a single click
  • Get notified by email for early access to discounts & offers on our products
Sign in

Comments

Comments have to be in English, and in full sentences. They cannot be abusive or personal. Please abide by our community guidelines for posting your comments.

We have migrated to a new commenting platform. If you are already a registered user of The Hindu and logged in, you may continue to engage with our articles. If you do not have an account please register and login to post comments. Users can access their older comments by logging into their accounts on Vuukle.