Denied health insurance,Hepatitis patient gets relief from forum

The Mumbai Suburban District Consumer Disputes Redressal Forum has ruled in favour of a Ghatkopar resident whose insurance claim was rejected by Royal Sundaram Alliance Insurance Co Ltd.

The Mumbai Suburban District Consumer Disputes Redressal Forum has ruled in favour of a Ghatkopar resident whose insurance claim was rejected by Royal Sundaram Alliance Insurance Co Ltd. The insurance company will have to pay Vallabh Shah the insurance amount of Rs 1.58 lakh along with 9 per cent interest from May 2008. Shah will also receive Rs 10,000 towards costs of the complaint.

Shah had contracted Hepatitis C in 2006 due to an infected blood transfusion during his treatment for ulcer and duodenal bleeding in 1988. He had to shell out Rs 1.58 lakh for treatment,but could not avail his medical insurance cover as the company turned his application down saying Hepatitis C was a pre-existing disease and thus not covered under the policy.

For almost two decades since the blood transfusion,Shah led a normal life,with no serious illness. However,in May 2006,he took seriously ill and had to be hospitalised for a prolonged period,Shah claimed in his petition.

In his complaint,Shah claimed he had taken an insurance policy from the company in 2003 for Rs 2.30 lakh. Soon after recovering from his ailment,Shah moved the medical papers to the insurance company as per the policy for reimbursement of hospitalisation expenses and costs of medicines. However,in September 2006,the insurance company,repudiated the claim on the ground that the hospitalisation was considered as treatment of pre-existing disease and that his case fell outside the scope of the policy.

Shah moved a grievance petition before the Insurance Ombudsman,but the petition was rejected in December 2007. In May 2008,Shah filed the complaint in the district forum alleging deficiency in service.

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