Woman Wins Rs 82000 Insurer Denies Tongue Cancer Treatment Claim

laim on grounds of non-disclosure after accepting that the policy had been ported and had been renewed continuously.

President Rajesh Bhatia and S Kanwar Jaswant Singh (member) were hearing a complaint filed by the woman, who sought reimbursement of Rs 72,212 spent on the treatment of leukoplakia of the tongue, a condition described in the proceedings as tongue cancer.

“The commission deems it appropriate to direct the OPs (insurance company) to reimburse the insurance claim along with compensation due to mental agony and harassment suffered by the complainant at the hands of the OPs,” the June 2 order read.

The counsel appearing for the insurance company, advocate Raman Kumar Sharma, argued that the complaint is not maintainable as the complainant cannot take advantage of her own wrongs.

It was claimed that the complainant herself is guilty of non-disclosure of material facts at the time of taking policy, as such the complaint is liable to be dismissed.

The complainant had ported the insurance policy from United India Insurance Co Ltd in 2015 and thereafter renewed it from time to time.

It was claimed that the complainant had knowledge that she was suffering from ulcerative colitis and had a whitish elevated lesion on the surface of the tongue (i.e., leukoplakia) at the time of purchasing insurance from the present insurance company, which was not disclosed in the proposal form and even in the medical examination form no such disclosure was made.

There was neither any deficiency in service nor any negligence in service nor any unfair trade practice on the part of the insurance company, it was further mentioned.

The complainant’s counsel pointed out that if there had been any such doubt in the mind of the insurance company, they should have got the complainant medically examined to ensure her health status before porting the insurance.

It was further added that this policy was ported with the insurance company in November 2015 and was accepted by the company after due investigation and observance of the standing instructions for porting of the same.

The counsel denied that her client had any knowledge about the history of a whitish elevated lesion on the surface of the tongue, being an internal development in the body.

It was further argued that the present insurance company has been skilfully trying to club the bygone mediclaim of ulcerative colitis, which was settled in 2017, with the present genuine claim of leukoplakia of the tongue.

It was submitted that due to a grave deficiency in service and unfair trade practice on the part of the insurance company, the complainant is entitled to all the reliefs.

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