RAJKOT: An insurance company’s arguments to reject a chain smoker’s lung cancer treatment claim went up in smoke as a Consumer Disputes Redressal Commission in Gujarat’s Rajkot ordered it recently to reimburse him the entire bill within a month.
Rajkot resident Madhukar Vora was admitted to a private hospital in the city in February 2018 and later referred to an Ahmedabad-based hospital, where he was diagnosed with carcinoma of the lungs. He was treated and filed a claim for Rs 6. 53 lakh as medical expenses. But Oriental Insurance Company Ltd rejected his claim on April 30, 2019 on the grounds that he was addicted to an intoxicant.
Vora approached the Consumer Disputes Redressal Commission, which observed that nicotine in cigarettes is not a proven intoxicating substance. Moreover, it was not proven that Vora’s disease was caused by smoking cigarettes.
The court said the insurance company defected in its service by creating baseless objections. The insurance company had argued: “We have come to know during our investigation and papers of hospitals that the complainant was smoking around 15 to 20 cigarettes a day for the last 40 years. Thus, as per the policy’s condition number 4. 8, this claim is subject to rejection. ”
The insurer argued that the policy’s condition states a claim can be rejected in case of drug/alcohol/intoxicant abuse or addiction. The complaint was a policy holder for the last 20 years.
Vora’s counsel Shailendrasinh Jadeja said, “The commission has ordered the insurance company to pay Rs 6 lakh within 30 days with a 6% interest and Rs 5,000 towards legal expenses. ”
