The Ahmedabad District Consumer Disputes Redressal Commission has ruled that diabetes and high blood pressure (hypertension) are lifestyle diseases and not illnesses that must automatically be disclosed while buying a health insurance policy. Because of this, the commission rejected the insurance company’s reason for denying a medical claim and ordered it to pay the insured amount.
According to the case details, Ahmedabad resident Rameshbhai Shah had purchased a health insurance policy from Chola Mandalam MS General Insurance Co. Ltd. Later, he had to undergo angioplasty, a heart procedure, and filed a claim to cover his medical expenses.
However, the insurance company rejected his claim. The company argued that Rameshbhai Shah had been suffering from diabetes and hypertension for many years before taking the insurance policy and had not disclosed these medical conditions. It claimed that if these facts had been revealed, the policy would either have been issued with different terms or would have excluded illnesses arising from diabetes and hypertension.
The commission carefully examined the case. After hearing both sides, it observed that diabetes and hypertension are lifestyle diseases and that not disclosing them does not automatically amount to hiding important or material facts while purchasing an insurance policy.
The commission therefore rejected the insurance company’s defence that the claim should be denied because of non-disclosure. It directed Chola Mandalam MS General Insurance Co. Ltd. to reimburse Rs 4.08 lakh to Rameshbhai Shah for the medical expenses incurred for his treatment.
The ruling states that simply having diabetes or high blood pressure before taking a policy cannot, by itself, be treated as suppression of material facts in this case, and the insurer must honour the claim.
Also Read: 8.1% Of Gujaratis Diabetic, Reveals Survey https://www.vibesofindia.com/8-1-of-gujaratis-diabetic-reveals-survey/
