Diabetes, hypertension not pre-existing disease, not grounds for claim rejection: Consumer Commission

New Delhi [India], February 21 (ANI): Allowing a complaint against an insurance company, the District Consumer Redressal Commission II ruled that, as per established law, lifestyle diseases like diabetes and hypertension cannot be treated as pre-existing conditions and therefore cannot be grounds for claim rejection by the insurer.
Therefore, these cannot serve as a valid reason for the insurance company to deny a claim.
A claim was rejected by the insurance company because the deceased did not disclose that he was suffering from diabetes and hypertension tension. The deceased had purchased insurance for his house loan.
The Commission while deciding the complaint also said, "Moreover, the non-disclosure" in respect of this lifestyle disease all diabetes, will not disentitled the complainant for indemnification of the claim in the light of the judgment of the High Court of Delhi in Hari Om Aggarwal Vs. Oriental-Insurance Corporation.
District Consumer Disputes Redressal Commission (South) passed an order in favour of Nishant Sharma, son of deceased Prem Shanker Sharma.
"This Commission is of the view that the claim of the complainant was wrongly rejected by the opposite party (OP) insurance company and the OP is therefore directed to pay the sum insured i.e Rs.45,00,000 with till its realization to the IDBI interest at the rate of 7% p.a from the date of rejection till its realisation to IDBI Bank within two months from the date of pronouncement, failing which OP shall be liable to pay interest at the rate of 9%p. a till realization, the Commission ordered.
The bench headed by President Monika Shrivastava further directed the OP to pay Rs. 25,000 as the cost of mental harassment caused to the complainant.
While deciding the complaint commission referred to the decision by the Delhi State Consumer Disputes Redressal Commission (SCDRC) which held that "from the aforesaid settled law it is clear that any lifestyle disease like diabetes and hypertension cannot be treated as pre-existing diseases therefore cannot be a ground of repudiation of the claim by the insurance company.
Advocate K K Sharma filed a complaint for Nishant Sharma who is one of the legal heirs of deceased Prem Shanker Sharma.
The complainant's father took a home loan of Rs.45,00,000 from IDBI Bank for 240 months at an interest rate of 7.40% per annum. The complainant, guided by his father, applied for an insurance claim after his father suffered a brain stroke, which is listed as a critical illness by the insurance company.
It was further stated that the father of the complainant suffered a stroke resulting in permanent illness which resulted in loss of independent existence" and loss of speech" which made him eligible for seeking a claim under the list of illnesses mentioned in the policy provided.
The complainant, under the guidance of his father, applied for an insurance claim as he was bedridden having suffered from a brain stroke and brain stroke was mentioned in the list of illnesses provided by the insurance company as one of the critical illnesses.
The complainant's father succumbed to ailments on September 11, 2023, is annexure-I and the complainant approached the insurance company and furnished all documents of his father and requested the insurance company to settle the entire loan amount with IDBI Bank.
Advocate K K Sharma argued that the insurance company maliciously persuaded the complainant to mention the lifestyle disease of the father even though he had never been hospitalised due to such lifestyle disease and it was not the cause of death of the father of the complainant.
He further stated that the cause of the death of the father of the complainant was due to a blood clot leading to a stroke. The insurance claim was denied on November 30, 2023.
It was also stated that the complainant was not in a position to pay the loan instalment after the death of his father as he was suffering from financial hardship and now the loan account is negative.
While rejecting the claim the insurance company had stated that the complainant/his father should have made full and frank disclosure of the history of illnesses suffered by him by those proposed to be insured in the proposal form as per IRDA Regulations, 2016.
The insurance claim was rejected on August 16, 2023, due to non-disclosure of the complainant's father's pre-existing conditions, diabetes and hypertension, which had been present for five to six years. (ANI)