Ncdrc Insurers Orders Rs 5 Lakh Mediclaim Payout Angioplasty

The National Consumer Disputes Redressal Commission has allowed the plea of a man who underwent angioplasty in 2018 but was denied Rs 5 lakh mediclaim on the ground that he had a ‘pre-existing’ condition. The ruling held that a health insurance claim cannot be rejected merely on an allegation of pre-existing hypertension without proof of suppression.

Justice A P Sahi (president) and member Bharatkumar Pandya were hearing a revision petition filed by Religare Health Insurance Co Ltd challenging an April 2022 order of the Punjab State Consumer Disputes Redressal Commission, which had upheld the complainant’s claim.

“The findings recorded by the district commission and the state commission that, in our opinion, are well reasoned, and in the absence of any cogent evidence to support the allegation of suppression of the alleged disease of hypertension, the contentions raised by Mr Seth, learned counsel for the insurance company, are unsustainable,” the June 9 order read.

Appearing for the insurance company, advocate Pankaj Seth urged that such suppression amounts to a violation and, consequently, the complainant’s negative answer in the proposal form clearly amounts to non-disclosure; hence, the claim was not indemnifiable.

He also urged that the terms of the contract are sacrosanct and therefore the answer given amounts to a breach of the terms of the contract.

He has also relied on the decision of the Supreme Court in other cases to urge that non-disclosure or suppression disentitles the claimant to any indemnification.

On the other hand, advocate Humraz Bir Singh, appearing for the complainant, argued that the concurrent findings of the district and state commissions did not warrant interference in the commission’s limited revisional jurisdiction.

Richa Sahay is a Legal Correspondent for The Indian Express, where she focuses on simplifying the complexities of the Indian judicial system. A law postgraduate, she leverages her advanced legal education to bridge the gap between technical court rulings and public understanding, ensuring that readers stay informed about the rapidly evolving legal landscape. Expertise Advanced Legal Education: As a law postgraduate, Richa possesses the academic depth required to interpret intricate statutes and constitutional nuances. Her background allows her to provide more than just summaries; she offers context-driven analysis of how legal changes impact the average citizen. Specialized Beat: She operates at the intersection of law and public policy, focusing on: Judicial Updates: Providing timely reports on orders from the Supreme Court of India and various High Courts. Legal Simplification: Translating dense "legalese" into accessible, engaging narratives without sacrificing factual accuracy. Legislative Changes: Monitoring new bills, amendments, and regulatory shifts that shape Indian society. ... Read More