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Tuesday, March 24, 2009

Insurance cos can't deny mediclaims on resurfacing of diseases

Insurance companies cannot deny claims to a person on re-surfacing of a disease on the ground that it was a pre-existing one, the Delhi Consumer Commisison has said.


The Commission bench headed by Justice J D Kapoor made a distinction between the diseases which could recur and the ailments which are pre-existing.

"Whenever a patient is discharged from a hospital, the inference is that he has been cured of disease but if there is some serious development arising out of the same ailment, it will not fall within the terminology of pre-existing disease," the panel said.

The panel's observations came on two cross-appeals filed by ICICI Lombard General Insurance Company Ltd and Chatur Singh Rathour against each other, challenging a District Forum's order, asking the insurance firm to pay Rs 80,000 including compensation to him.

The Commisison partly allowed the insurance firm's appeal saying the consumer had concealed the fact about his wife's admission in the hospital for treatment of a certain disease.

The Commission reduced the amount by 50 per cent to be paid by the company to Rathour towards medical expenses.

source: Economic Times
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