Cancer patient wins ₹6.7 lakhs after suing insurance firm
A consumer court in Bengaluru ruled that hypertension and diabetes are not grounds for any patient to be denied his or her rightful insurance money after a 60-year-old cancer patient was denied his claim amount.
A 60-year-old ailing cancer patient from Bengaluru won Rs. 6.7 lakhs after he sued a private insurance firm for denying him medical insurance for his cancer treatment on grounds that he had hypertension and diabetes, which he had not disclosed prior to taking the policy.
In the court battle that lasted nearly eight months, judges reprimanded the private firm, called Religare Health Insurance Company, and said that hypertension and diabetes are not diseases but common physical disorders and that they cannot be grounds to deny medical insurance.
The court added that the insurance is the patient's rightful claim and that Religare, in this case, showed no concern for an ailing patient who paid his premium on time without fail.
The court then ordered the firm to pay the cancer patient the insured sum of Rs. 5 lakh with a 12% interest and a compensation of Rs. 1.1 lakh for the additional trauma and mental agony caused by the denial of insurance money, with another Rs. 10,000 toward court expenses and damages.
Reports said that the 60-year-old man is an Indiranagar resident and had purchased a family cover insurance policy from Religare in November 2011. He was diagnosed with cancer in 2018, uptil which he was renewing the medical insurance policy every year diligently. When his cancer treatment at the HCG Hospital amounted to about Rs. 11 lakh, he approached Religare to get the insured sum of Rs. 5 lakh refunded.
Reports said that the insurance company however denied him the claim amount and cited that he is not applicable for the insurance money as he had not disclosed his pre-existing conditions of hypertension and diabetes when taking the policy.
Dismayed and without any reasonable explanation from the insurance company for several months, the petitioner sent the firm a legal notice and sued them in the Bengaluru Rural and Urban 1st additional district consumer disputes redressal forum in the Shantinagar area for unfair trade practices.
The judges of the Bengaluru consumer forum slammed Religare for high-handedness towards a cancer patient and on March 29, 2022, gave the order for the patient to be compensated accordingly by the firm. In previous instances, the Supreme Court has observed that conditions like hypertension and diabetes are not grounds to deny rightful insurance money to patients.