Insurance Firm Penalized for Unjust Denial of Cancer Patient's Claim

The award passed by the ombudsman has to be complied with in letter and spirit, Justice Prasad said.The woman had taken an insurance cover of Rs 44.5 lakh from the firm and was diagnosed with stage-IV breast cancer, which has now spread from the primary organ to lymph nodes and to both her lungs.

The Delhi High Court has imposed costs of Rs 50,000 on New India Assurance Company Ltd for the ''harassment and mental agony'' caused to a cancer patient, who was deprived of the claim amount.

The high court also directed the insurance firm to clear within four weeks the amount to the woman, battling with breast cancer, who has claimed Rs 11 lakh for the cost of treatment undergone by her.

Justice Subramonium Prasad said there was no ambiguity in the medi-claim policy and the sub-limit of Rs 2 lakh will not be applicable to chemo-immunotherapy which is a new form of treatment and is a combination of chemotherapy and immunotherapy without the sub limit being applicable.

''In view of the fact that the petitioner, who is a cancer patient, has been harassed without any reason and has been deprived of the amount putting her to mental agony, this court is inclined to impose costs of Rs 50,000 on respondent no.1/ insurance company to be paid to the petitioner within four weeks,'' the court said.

The high court said the award passed by the insurance ombudsman, which had directed the firm to settle the complainant's claims, has to be complied with in letter and spirit.

The court refused to accept the contention of the counsel for the insurance firm that the claim of award has already been paid to the petitioner woman.

''The fact that the insurance company has already paid Rs 37 lakhs to the petitioner is not relevant to the present claim and the insurance company has to pay the amount as claimed by the petitioner. The award passed by the ombudsman has to be complied with in letter and spirit,'' Justice Prasad said.

The woman had taken an insurance cover of Rs 44.5 lakh from the firm and was diagnosed with stage-IV breast cancer, which has now spread from the primary organ to lymph nodes and to both her lungs. She was undergoing chemo-immunotherapy treatment.

The plea said she made a claim under the insurance policy and it was denied by the insurer on the ground that the claim exceeds the terms of the policy as a claim for treatment for giving monoclonal antibody injections cannot exceed Rs 2 lakh.

Aggrieved by the insurer's decision, the petitioner filed a complaint to the ombudsman claiming an amount of Rs 11 Lakh for the cost of her treatment which was allowed.

Since the award was not being complied with, the woman approached the high court with this petition.

(This story has not been edited by Devdiscourse staff and is auto-generated from a syndicated feed.)