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    • Mediclaim cannot be...

    Mediclaim cannot be denied on presumption of pre-existing disease: NCDRC

    Medical Dialogues BureauWritten by Medical Dialogues Bureau Published On 2019-06-09T11:15:21+05:30  |  Updated On 14 Aug 2021 11:43 AM IST



    The commission also said in its view, diabetes was a lifestyle disease in India and the whole insurance claim (Mediclaim) cannot be rejected only based on this ground.


    New Delhi: The National Consumer Disputes Redressal Commission (NCDRC), the apex consumer commission, has held that a medical insurance claim (Mediclaim) cannot be denied on the mere presumption that a person might be suffering from a pre-existing disease.

    NCDRC said even if the insured person was suffering from a disease and did not know about it nor was taking any treatment for the same, the claim cannot be denied by an insurance company.

    The observations by the commission came while rejecting the revision plea filed by Reliance Life Insurance Co. Ltd against the Maharashtra state commission's order dismissing its appeal challenging a district forum's direction to pay Rs 1,12,500 to the husband of one of its policyholders who died of diabetic ketoacidosis.

    The district forum had also awarded Rs 5,000 towards physical and mental trauma, and Rs 3,000 as litigation cost to the husband who had filed the complaint against the insurance company.

    Read Also: Only doctor can decide line of treatment of a patient, NOT insurance company: Consumer Court

    The NCDRC, while dismissing the revision plea, said the onus to prove the pre-existing disease lies on the insurance company.






    The commission also said in its view, diabetes was a lifestyle disease in India and the whole insurance claim cannot be rejected only based on this ground.






    Rekha Halder died of diabetic ketoacidosis on June 24, 2011.

    She was insured under a policy plan of Reliance Life Insurance Co Ltd since July 12, 2010. However, the insurance company repudiated the claim on the ground of non-disclosure of material information.

    On the complaint of Halder's husband, the district forum of Jalgaon, Maharashtra, had passed an order directing the company to pay him over Rs 1.12 lakh.

    Read Also: People run from pillar to post to get insurance claim from companies: Delhi consumer commission



    best insurance policyblood sugardenieddiabetesdiabetic ketoacidosisIndiainsuranceInsurance claiminsurance for doctorsinsurance policyJalgaon Maharashtralifestyle diseaselitigation costmaharashtraMedical Claimmedical insurancemediclaimmental traumaMumbaiNational Consumer Disputes Redressal CommissionNCDRCNew Delhipolicy planRekha HalderReliance Life Insurancetreatment
    Source : PTI

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    Medical Dialogues Bureau
    Medical Dialogues Bureau

      Medical Dialogues Bureau consists of a team of passionate medical/scientific writers, led by doctors and healthcare researchers.  Our team efforts to bring you updated and timely news about the important happenings of the medical and healthcare sector. Our editorial team can be reached at editorial@medicaldialogues.in. Check out more about our bureau/team here

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