Mediclaim Cannot Be Denied On Presumption Of Pre-Existing Disease: NCDRC

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

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

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

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. She was insured under a policy plan of Reliance Life Insurance Co Ltd since July 12, 2010.  On the complaint of Halder’s husband, the district forum of Jal aon Maharashtra had assed an rder directin the com a to him over Rs 1.12 lakh. – Medical Dialogues
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