The state consumer commission ruled against Oriental Insurance Co Ltd (OICL) for rejecting a Mediclaim on the grounds of concealing pre-existing conditions of diabetes mellitus (DM) and coronary artery disease. The commission found faith in the complainant’s assertion that in an analogous case, the National Consumer Commission has adjudicated that “diabetes is a lifestyle-related ailment and is so pervasive in India that the entire insurance claim cannot be denied on this basis.” The order was issued on Monday and made public on Wednesday.
Anshul Garg, a resident of US Nagar, had purchased a Mediclaim policy of Rs 2 lakh for himself and his parents in 2013. In July 2014, his father underwent cardiac surgery, which cost around Rs 5 lakh. Garg submitted the necessary documents to OICL for reimbursement but his claim was denied, forcing him to approach the consumer court.
In March 2018, the district consumer commission ruled in favor of Garg, directing OICL to pay a compensation of Rs 2 lakh, along with 7% interest from the date of filing the case and Rs 15,000 for mental anguish and litigation expenses. OICL then challenged the order in the state commission.
After reviewing the documents, the state commission concluded that OICL did not provide any credible evidence to support their claim that there was concealment of pre-existing illness while filling up the proposal form. The commission stated that OICL failed to establish that the father of the respondent had been suffering from DM for the last 15 years and as per the doctor’s report, the pre-existing disease was the primary cause of coronary artery blockage.
“Thus, we are of the considered opinion that the district commission has perfectly and legally passed the judgment,” the division bench comprising president Kumkum Rani and member BS Manral said and directed OICL to pay Rs 2 lakh with 7% interest from April 2014 and Rs 5,000 as litigation costs to the complainant.