‘Past ail­ment can’t be termed disease to re­ject claim’

Hindustan Times ST (Mumbai) - HT Navi Mumbai Live - - FRONT PAGE - Kanchan Chaudhari [email protected]­dus­tan­times.com

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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