Hypertension no bar: Insurance agency asked to pay 2L claim
DCDRC president Praveen Kumar Jain and members RP Singh and Shailja Sachan also ordered the insurer – Religare Health Insurance Company – to pay Kapil Anand Rs 5,000 as compensation for litigation costs and denial of the claim filed in 2019.
The payment must be made within 45 days, and failure to comply will attract 6% simple interest on the outstanding amount. In a plea filed with the consumer commission, Anand said he'd bought the Rs 5-lakh policy from Religare after paying a premium of Rs 17,150 on March 3, 2019.
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In Oct that year, he felt "discomfort" in his chest and was admitted to Yashoda Hospital.
"… doctors diagnosed me with a blockage in the heart and I underwent the medical procedure of stenting in the heart," he said.
The third-party administrator, he said, refused to pay his hospital bill of Rs 2,16,482 lakh, forcing him to pay it on his own. Religare's counsel argued before the commission that Anand did not disclose his history of hypertension at the time of buying the policy.
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"The discharge slip, consultation papers, and past history of the patient mentioned that he suffered from hypertension for the last two years and he did not disclose this at the time of purchasing the policy," the counsel said, adding that any condition linked to hypertension cannot be honoured for a claim.
The commission in its July 26 order cited two previous judgments by NCDRC-New Delhi to rule in favour of Anand. In the 2013 Ravindra Bindra vs National Insurance Company case, the Delhi commission had ruled that hypertension history could not be grounds for rejecting heart treatment claims, it said.
In another 2013 case (Satish Chandra Madan vs Bajaj Alliance), NCDRC rejected the argument that hypertension was a chronic disease.
"In the case Satish Chandra Madan Vs Bajal Alliance General Insurance Company, National Consumer Disputes Redressal Commission held that the petitioner was a patient of hypertension before securing the insurance policy. Hypertension is a common ailment that can be treated through medicines and it is not necessary that hypertension was linked to heart attack. Hypertension is a lifestyle disease and by rejecting the claim, insurance company is guilty of deficiency in service," the Ghaziabad commission said in its order.
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