The District Commission said that common lifestyle diseases, like diabetes and hypertension, cannot be treated as pre-existing diseases.
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Dakshina Kannada Consumer Disputes Redressal Commission has ruled that an insurance firm can’t reject the claim for reimbursement of treatment expenses on the ground that the claimant had diabetes mellitus for long.
Hearing a case, the commission directed Bajaj Alliance General Insurance Company Limited to pay 70-year-old K.S. Rajeeva, a resident of Kulai in Mangaluru taluk, ₹48,872 with 8% interest from February 15, 2023, till realisation of the amount. The insurance firm has also been directed to pay Mr. Rajeeva a sum of ₹10,000 as compensation, and ₹5000 as cost of proceedings.
Mr. Rajeeva had taken a medical insurance policy from Bajaj Alliance and it was valid for the period between November 9, 2022, and November 18, 2023. Mr. Rajeeva was admitted to Omega Hospital in Kankanady following a breathing problem and he underwent treatment for the period between September 30, 2022, and October 2, 2022. He spent ₹48,872 towards treatment. Mr. Rajeeva submitted the claim to the insurance firm for reimbursement of the amount.
On December 9, 2022, the insurance firm rejected the claim on the ground that the claimant had diabetic mellitus for 27 years and it was a known case of diabetes. Contending that he is entitled to claim treatment expenses within the limitation of policy condition, Mr. Rajeeva filed the complaint before the District Commission accusing the insurance firm of deficiency in service and unfair trade practice.
The District Commission comprising of president K. Prakasha and Members P.V. Lingaraju and H.G. Sharadamma, in its judgement dated January 17, 2024, referred to the 2022 decision of Delhi State Consumer Disputes Redressal Commission, wherein it was said that common lifestyle diseases like diabetes and hypertension cannot be treated as pre-existing diseases. And this cannot be grounds for insurance firms to reject the claim, the Delhi Commission stated.
“In view of the above citation, we are of the opinion that the opposite party (insurance firm) is not justified in repudiating the claim of the complainant as pre existing on the ground that the complainant is known case of diabetes mellitus for 27 years,” the District Commission said.
