Surat: The Surat District Consumer Disputes Redressal Commission has directed Religare Health Insurance Company Ltd to pay Rs 2.95 lakh towards an insurance claim for oral cancer treatment, along with 8% interest, compensation and litigation costs, after holding that the insurer could not justify rejecting the claim on the ground of non-disclosure of a heart condition.The commission partly allowed a complaint filed by a 51-year-old Olpad resident, who had obtained a mediclaim policy with a sum insured of Rs 3 lakh for the period from Oct 26, 2019 to Oct 25, 2020.During the policy period, he was admitted to a city-based hospital on Feb 10, 2020 after developing health problems. He was diagnosed with carcinoma of the left buccal mucosa and underwent surgery on Feb 11. He was discharged on Feb 17, 2020.The complainant submitted a claim of Rs 2.95 lakh towards the treatment expenses. However, the insurance company rejected the claim on March 16, 2020, alleging that he had failed to disclose a pre-existing heart condition, described as mitral valve prolapse (MVP), while taking the policy.During the proceedings, the complainant’s advocate Shreyas Desai argued that there was no connection between the heart condition and the cancer for which the insured had undergone treatment. The treating doctor stated that there was no nexus between MVP and the cancer treatment.The commission observed that the insurer had failed to successfully rebut the treating doctor’s certificate. It held that the insurer’s defence could not be sustained and that rejection of the claim was neither reasonable nor justified.
