‘Past ailment can’t be termed disease to reject claim’
MUMBAI: Insurance companies cannot reject medical insurance claims by calling a past ailment or surgery a ‘pre-existing disease’, the Mumbai suburban district consumer forum said on Tuesday.
The district forum held the New India Assurance Company Limited guilty of deficiency in service, for rejecting the claim of Vile Parle resident Gopal Krishna Pillai, for an angioplasty he underwent in September 2007.
In his complaint, Pillai said he had undergone an angioplasty on September 9, 2007, which cost him Rs4.21 lakh. Two days later, he said he submitted a claim. The company, however, repudiated it categorising the surgery as ‘preexisting disease’, which makes it fall under the exclusion clause.
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