Moderate alcohol intake can’t be ground for rejecting medical claim

The district consumer grievances redressal forum in a recently passed order said moderate consumption of alcohol cannot be used as grounds to reject medical insurance claims. The Forum directed New India Assurance Company Limited to reimburse complainant Giani Ram Saini (51) Rs. 1,28,677 which was incurred by the complainant on his medical treatment along with interest at 9% per annum. The complainant is also entitled to compensation of Rs. 50,000 as well as Rs. 22,000 as litigation expenses. The rejection was on the grounds of Giani Ram Saini had not disclosed at the time of taking the policy that he was suffering from a pre-existing disease “liver abscess being a chronic alcoholic”.

Saini in his complaint said he his wife and children had held the health insurance policy for the period from 9.2.18 to 8.2.19. In May 2018, he felt abdominal pain and was admitted to the Institute of Liver & Billiary Sciences, Vasant Kunj, New Delhi.

Thereafter conducting the necessary tests, the doctor found a liver infection and the complainant remained admitted for his medical treatment in the hospital from 8.5.2018 to 14.5.2018. The complainant incurred Rs. 1,28,677 for his entire treatment. But the complainant said, his claim for reimbursement was rejected by the insurer company, and he was only discharged after his family paid out-of-pocket. In its response, New India Assurance Company said Saini had not disclosed at the time of taking the policy that he was suffering from a pre-existing disease “liver abscess being a chronic alcoholic”.