Mumbai: Religare Health Insurance Ordered To Pay ₹8.56 Lakh For Denied Chemotherapy Bills By Consumer Commission

The Suburban Mumbai Additional District consumer dispute redressal commission (DCDRC) has pulled up the Religare health care insurance company, who had rejected to pay for the the chemotherapy bills of its consumer on the grounds that the consumer had failed to inform the firm about her medical conditions of hyper-lipidemia and her allergic asthma. The commission in its orders held that there was no nexus or causative connection between the suppression of hyperlipidemia and her current claim of carcinoma (breast). 

The commission has asked the insurance firm to pay towards the complainant’s medical bills of Rs 8,56,592 along with nine per cent interest on the amount from November 2014. The commission has also asked to firm to refund the policy amount of Rs 24,875, accompanied by additional amounts of Rs 25,000 and Rs 15,000 towards the complainant’s mental agony and litigation charges, accordingly.

Hitesh Sheth, a resident of Ghatkopar, had purchased a mediclaim policy for himself and his wife, from Religare health care for Rs 24,875, which was valid for a year starting from November 30, 2013. In April, 2014,  as she detecting a lump in her right breast and a cyst  in her left breast, Anjana was admitted in  Somaiya Ayurvihar Asian Institute of oncology. The said medical condition was recovered by performing operation and later administering her with chemotherapy. The medical bills were accordingly submitted to the insurance firm seeking for a refund.

The insurance firm , however after going through the papers, pointed out that Anjana was suffering with the conditions of hyper-lipidemia and her allergic asthma, and which the company was not informed about and thus the claim deserves  to be repudiated.

The forum after going through the evidence, had asked the firm to file its reply, where the company said, “The medical documents collected revealed the fact that the wife of the complainant was known case of hyper-lipidemia and allergic asthma since 2005 and the complainant did not disclose the said fact in the proposal form while taking the insurance policy and accordingly complainants claim were rejected as per policy clause.”

The commission, however rejected the company’s say, and asked them to pay for the complainant’s medical expense.