3 min readChandigarhOct 6, 2025 11:22 PM IST
First published on: Oct 6, 2025 at 11:21 PM IST
Observing that a Chandigarh resident’s genuine medical treatment claim was rejected on the grounds of alcohol consumption, the District Consumer Disputes Redressal Commission has directed an insurance firm to pay Rs 4 lakh, along with Rs 10,000 each as compensation and cost of litigation.
The Chandigarh-based complainant, Inderjit Singh, 34, stated that he has been taking the health insurance policies from the Star Health and Allied Insurance since 2014 and the premium was being deducted from his salary.
Singh’s counsel, Advocate Harpreet Saini, contended before the commission that on January 17, 2020, he suffered pain in his stomach and approached Jain Clinic at Sector 21, Chandigarh, where he was advised to have an ultrasound. After the ultrasound, he was told that there was a small stone in his gall bladder and was advised for its removal. He was then taken to the PGIMER, Chandigarh for treatment, where he was referred to the ward of gastroenterology where he was treated. His pancreas was also affected and per Singh’s counsel claimed that it was not due to alcohol.
The complainant was discharged from the hospital on March 18, 2020, and was asked to spend an amount of Rs 4,59,291 on his treatment. He submitted his treatment claims with the insurance company, but these were rejected on the grounds that the disease was due to “use of alcohol”. Singh then filed a complaint before the consumer panel against Star Health and Allied Insurance on the rejection of his claim.
The insurer, in its reply, submitted that Singh was diagnosed to be suffering from ANP (acute necrotizing pancreatitis), AKI (acute kidney injury) and ALI (acute lung injury). As per the discharge summary, the complainant was diagnosed with ANP, a health problem in which part of the pancreas or tissues around it die and the same happens after inflammation or injury by mentioning that gallstones and drinking a lot of alcohol are the two most common causes of pancreatitis, Star Health and Allied Insurance claimed.
The insurance company further argued that the present ailment and treatment of the insured was due to intake of alcohol and as per Exclusion Clause No. 8 of the policy, they are not liable to make any payment in respect of expenses incurred at the hospital for treatment of the diseases due to use of alcohol, and so the claim was rejected.
The commission after hearing the arguments, observed that nothing in the discharge summary suggested that the treatment was due to use of alcohol only, rather it noted that the complainant was treated for ANP, in which part of the pancreas or tissues around it died and the same happens after inflammation or injury and having gallstones and drinking a lot of alcohol are the two most common causes of pancreatitis.
It noted that when there is no “concrete and convincing evidence on record” that the complainant was drinking a lot of alcohol. The consumption of alcohol was also not the only reason for his diseases, the commission held.
Observing that the insurance firm has wrongly repudiated the genuine claim of the complainant by misinterpreting the terms and conditions of the policy, the commission directed Star Health and Allied Insurance to pay Rs 4 lakh, along with Rs 10,000 each as compensation and cost of litigation.
The commission after hearing the arguments, observed that nothing in the discharge summary suggested that the treatment was due to use of alcohol only 
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