A district consumer commission ordered an insurance company to pay a medical insurance claim that the insurer had earlier denied. The insurance company had said that the health complications the patient had developed were due to vitamin B12 deficiency, caused by a lack of dietary supplements, as the patient is a vegetarian.
The commission directed the insurer to pay the claim, asserting that the patient being vegetarian was not his fault.
Meet Thakkar of Naranpura was treated for giddiness, nausea, heaviness in the left part of his body and weakness, at a private hospital, for a week in October 2015. He was diagnosed with transient ischaemic attack (TIA) and his homocysteine level was 23.52 against the normal range of 5 to 15. He incurred a bill of Rs 1.06 lakh.
Thakkar had a health cover of Rs 5 lakh from the New India Assurance Co Ltd. The insurer, however, denied the claim, citing the relevant exclusion clause to state that the patient’s dietary habits had caused the complication and hence the claim was not payable.
Thakkar sued the insurer with the Consumer Dispute Redressal Commission, Ahmedabad District (Additional). After hearing the case, the commission said vegetarian people may face B12 deficiency, but Thakkar’s health complication cannot be construed to have been caused due to his inadequate diet or as a result of his own fault. The doctor said that vegetarian people usually suffer from B12 deficiency, but the insurance company misinterpreted it and refused the claim.
The commission ordered the insurer to pay Rs 1.06 lakh with nine percent interest since October 2016. The insurer has also been ordered to pay Rs 5,000 as compensation to Thakkar for mental agony and legal expenditure.
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