The state consumer commission has directed an insurance company to pay Rs 82 lakh, along with a compensation of around Rs 10 lakh, to the widow of a man who died of mouth cancer in 2010.
It held Life Insurance Corporation of India had wrongly repudiated the claim saying the man had a habit of chewing gutka and suffered from dyspepsia, a problem related to indigestion.
Relying on a national commission order in a similar matter, the panel observed non-disclosure of chronic dyspepsia in the proposal form cannot be a ground for repudiation.
"It is not a disease in itself but symptomatic of other diseases or disorders, characterized by vague abdominal discomfort, a sense of fullness after eating, eructation, heartburn, nausea and vomiting and loss of appetite," the commission said.
The commission observed the medical summary clearly said Rajendra Chavan chewed gutka 14 years prior to his death and not for 14 years as the insurance company claimed.
It noted the summary showed Chavan had been suffering from cancer for only about a month before his death.
"There is no valid document to rely on the contention of the insurance company to establish that the oral cancer was detected prior to the submission of the proposal form," the commission said.
It pointed out when the company's medical officers had certified Chavan's health before issuing the policies, the cancer was nonexistent.
The complainant Kalpana Chavan's husband had procured three separate policies for Rs 30 lakh, Rs 27 lakh and Rs 25 lakh.
On September 6, 2010, Chavan died at a hospital in Pune after suffering from mouth cancer.
Kalpana intimated the insurance company and submitted the three claims. The company obtained Chavan's medical summary from the hospital and concluded that he had suppressed the fact that he chewed gutka and suffered from dyspepsia.
It repudiated the claims in April 2011. Kalpana filed three separate complaints before the Maharashtra State Consumer Disputes Redressal Commission last year. The commission passed a common order in the three complaints.
Article referred: http://articles.timesofindia.indiatimes.com/2013-12-29/mumbai/45674555_1_rs-10-lakh-mouth-cancer-gutka
It held Life Insurance Corporation of India had wrongly repudiated the claim saying the man had a habit of chewing gutka and suffered from dyspepsia, a problem related to indigestion.
Relying on a national commission order in a similar matter, the panel observed non-disclosure of chronic dyspepsia in the proposal form cannot be a ground for repudiation.
"It is not a disease in itself but symptomatic of other diseases or disorders, characterized by vague abdominal discomfort, a sense of fullness after eating, eructation, heartburn, nausea and vomiting and loss of appetite," the commission said.
The commission observed the medical summary clearly said Rajendra Chavan chewed gutka 14 years prior to his death and not for 14 years as the insurance company claimed.
It noted the summary showed Chavan had been suffering from cancer for only about a month before his death.
"There is no valid document to rely on the contention of the insurance company to establish that the oral cancer was detected prior to the submission of the proposal form," the commission said.
It pointed out when the company's medical officers had certified Chavan's health before issuing the policies, the cancer was nonexistent.
The complainant Kalpana Chavan's husband had procured three separate policies for Rs 30 lakh, Rs 27 lakh and Rs 25 lakh.
On September 6, 2010, Chavan died at a hospital in Pune after suffering from mouth cancer.
Kalpana intimated the insurance company and submitted the three claims. The company obtained Chavan's medical summary from the hospital and concluded that he had suppressed the fact that he chewed gutka and suffered from dyspepsia.
It repudiated the claims in April 2011. Kalpana filed three separate complaints before the Maharashtra State Consumer Disputes Redressal Commission last year. The commission passed a common order in the three complaints.
Article referred: http://articles.timesofindia.indiatimes.com/2013-12-29/mumbai/45674555_1_rs-10-lakh-mouth-cancer-gutka
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