Governance: Insurance companies cannot use diabetes to deny claim

From time to time, we come across cases where an insurance company will deny medical insurance to a person desperately needing the insurance; and why do they do so ? Well, obviously for an insurance company, the less claims that they can pay out, the more their profits. And in the case of medical insurance, using an excuse such as diabetes or hyper-tension gives an easy way to avoid making the insurance payment. If the concerned patient has either of these 2 modern diseases (that are very prevalent), then the insurance company can claim that these are pre-existing diseases and hence the claim can be rejected. This gambit must have succeeded in a number of cases, till this gentleman filed a case in the consumer forum against the insurance company and the consumer court rejected the contention of the insurance company:

The National Consumer Disputes Redressal Commission has ruled that the claim for a particular ailment cannot be rejected merely because the insured person is suffering from some other disease, say for instance, diabetes. Diabetes and hypertension are two of the standard dodges used by insurance companies to reject claims.

Insurance companies attempt to name these diseases as the cause for any ailment—and consequently, claims for other diseases are rejected on grounds of the pre-existence of hypertension and diabetes. The ruling came in the case of one Raj Kumar Chuchra who was insured under a mediclaim policy issued by New India Assurance Co Ltd for Rs 1,50,000.

As such stories proliferate, they will also raise the consciousness about the rights of a consumer and how they should actively go to a consumer court for getting their rights. And if this ruling is used as a precedent, it will help a lot of people who have medical insurance and also have diabetes or hypertension.

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