Times of India
19 September 2011
By, Rebecca Samervel
Undergoing treatment for hepatitis C in 2006, which he contracted due to an infected blood transfusion in 1988, cost a Ghatkopar resident his health and Rs 1.58 lakh.
To his relief, the Mumbai Suburban District Consumer Disputes Redressal Forum on Thursday ordered Royal Sundaram Alliance Insurance Co Ltd to pay the claim that it had rejected on the grounds that in this case, hepatitis C was a preexisting disease and not covered by the policy.
The forum observed that years had gone by with no adverse effects of the transfusion surfacing and the first symptoms were only seen in 2006. “Therefore, not mentioning blood transfusion undergone in 1988 while purchasing the policy in 2003 cannot be termed as suppression of material fact,” the forum observed.
The insurance company will now have to pay the victim, Vallabh Shah, Rs 1.58 lakh along with 9% interest from May 2008. Additionally, Shah
will receive Rs 10,000 towards costs of the complaint.
Shah had taken an insurance policy in 2003 for Rs 2.30 lakh. In May 2006, he was hospitalized for hepatitis C. Shah submitted his claim under the policy for reimbursement of hospitalization expenses.
In September 2006, the insurance company rejected the claim as the hospitalization was considered as treatment of a pre-existing disease, which was outside the scope of the policy. In May 2008, Shah filed a complaint in the forum, alleging deficiency in service.
The insurance company stated that in 1988, before inception of the policy, Shah underwent blood transfusion and this fact was suppressed by him while submitting the proposal form in 2003. Shah admitted that he did undergo the blood transfusion in 1988, but was unaware that the blood was infected. The forum refuted the insurance company’s defence and said that it has not produced evidence to show that Shah underwent treatment for the infection before 2006 and that he suppressed this fact.