Smoking cannot be equated with consumption of intoxicating alcohol/drugs, the south Mumbai district consumer forum held last week while allowing the complaint of a casual smoker, whose medical insurance claim had been repudiated by National Insurance Company Limited on the basis of a clause excluding diseases caused by intoxicating alcohol/drugs.
Nerul resident VK Sasikumar, a stenographer, had bought a medical insurance policy from the company and during the policy period, he was admitted to Bombay Hospital in October 2007 with clotting in an artery of a leg. He underwent a surgery which cost him Rs2.05 lakh.
Before he was hospitalised, Sasikumar had consulted an agent of the insurance company. However, the company later repudiated his claim under a clause that excluded medical conditions caused by “use of intoxicating alcohols/drugs.”
Sasikumar approached the consumer forum in July 2008, contending he was neither an alcoholic nor a drug user. He said that the illness had no direct connection to his occasional smoking.
The insurance company contested the claim saying smoking eight to 10 cigarettes a day was equivalent to consumption of intoxicating substances, which had caused the illness. The company relied on the report of the doctor who treated Sasikumar at Bombay Hospital which stated: “Tobacco use may have been the probable cause for the peripheral vascular disease.”
The bench of forum president SM Ratnakar and member SS Patil held that the exclusion clause was not applicable in the case, as intoxication meant consumption of an alcoholic drink or drug. It also discarded the contention linking the disease with smoking, saying the fact that the complainant worked as a stenographer for 30 years could have led to the problem, as he had to continually remain seated for the job.
The forum directed the company to pay Sasikumar, within four weeks, the claim amount of Rs1 lakh with interest at the rate of 9% per annum from July 2008, when he lodged the complaint, along with Rs15,000 toward compensation and cost of the litigation.