Insurance company cannot reject claim for cancer just because of “Smoking”
- Posted by CERC India
- Posted in Press Releases
18 January 2022
Smoking is one of the many factors that may lead to cancer. However, it is not the only cause and the insurance companies cannot use it as an excuse to reject the insurance claim. Recently, a consumer court made note of this and asked the insurance company to pay the claim amount to the complainant.
Alok Banerjee had a mediclaim policy from Oriental Insurance Company. He underwent treatment for adenocarcinoma of lung and incurred medical expenses of Rs. 93,297. The insurance company rejected his claim by stating that the medical papers reveal Mr. Banerjee to be a chain smoker. Unfortunately, Mr. Banerjee passed away. Later, his wife approached Consumer Education and Research Centre (CERC) for help in getting the mediclaim amount from the insurance company.
CERC filed a consumer complaint on behalf of Mrs. Banerjee in the District Commission, Ahmedabad. CERC advocates presented the facts of the case and were able to convince the court that the insurance company had arbitrarily rejected the claim of Mr. Banerjee.
Advocate Abhishek Awasthi of CERC said “After hearing both the parties, the Commission did not agree with the argument that the medical papers showed Banerjee’s smoking habit as the cause of his cancer. It also cited that discharge summary itself cannot be treated as primary or conclusive evidence in absence of independent proof and also there was no evidence in the matter to show that the patient got cancer due to smoking. The court has directed the insurance company to pay to Mrs. Banerjee Rs. 93,297 with 7% interest along with compensation towards mental harassment and cost of litigation.”
Many times insurance companies arbitrarily reject claims and leave the consumers very dejected. CERC has time and again brought justice to such consumers through our mediation as well as litigation efforts.
For more information, please contact
Mr. Abhishek Awasthi on 8849246270