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AHMEDABAD: Consumer court ordered insurance company to reimburse medical treatment expenses for lung cancer after company denied mediclaim on grounds that patient was a die-hard smoker and contracted cancer because of his smoking. The consumer court said there was no evidence the cancer was caused by the patient’s smoking habit.
The case involved an Alok Kumar Banerjee from Thaltej, who underwent treatment for adenocarcinoma of the lung from the Vedanta Institute of Medical Sciences in July 2014 and incurred a medical bill of Rs 93,297. He had insurance coverage. medical. But his request was rejected by the insurer.
After Banerjee’s death, his widow Smita sued the insurer in 2016 before the Consumer Dispute Redressal Commission in Ahmedabad (supplemental), where the insurance company defended that Banerjee had been treated at different hospitals for his illness, which had a direct link with his smoking habit, and this was reflected in his case papers.
The Consumer Commission disagreed. He cited a higher court order and said that a discharge summary itself cannot be treated as primary or conclusive evidence in the absence of any independent evidence. There was no evidence in this case to show that the patient got cancer from smoking.
The insurance company doctor gave a medical opinion that smokers have a 26 times higher risk of developing cancer. At this, the commission stated that on the sole basis of this opinion, it cannot be concluded that the patient had cancer due to his smoking habit. Those who do not smoke also have lung cancer and it cannot be believed that everyone who smokes has lung cancer. It cannot be accepted that the complainant’s husband had cancer from his smoking habit and that the insurer wrongly rejected the claim, added the commission.
In addition to ordering the insurer to reimburse the medical costs, the commission asked it to pay an additional Rs 5,000 to the complainant for compensation for moral harassment and legal expenses.
The case involved an Alok Kumar Banerjee from Thaltej, who underwent treatment for adenocarcinoma of the lung from the Vedanta Institute of Medical Sciences in July 2014 and incurred a medical bill of Rs 93,297. He had insurance coverage. medical. But his request was rejected by the insurer.
After Banerjee’s death, his widow Smita sued the insurer in 2016 before the Consumer Dispute Redressal Commission in Ahmedabad (supplemental), where the insurance company defended that Banerjee had been treated at different hospitals for his illness, which had a direct link with his smoking habit, and this was reflected in his case papers.
The Consumer Commission disagreed. He cited a higher court order and said that a discharge summary itself cannot be treated as primary or conclusive evidence in the absence of any independent evidence. There was no evidence in this case to show that the patient got cancer from smoking.
The insurance company doctor gave a medical opinion that smokers have a 26 times higher risk of developing cancer. At this, the commission stated that on the sole basis of this opinion, it cannot be concluded that the patient had cancer due to his smoking habit. Those who do not smoke also have lung cancer and it cannot be believed that everyone who smokes has lung cancer. It cannot be accepted that the complainant’s husband had cancer from his smoking habit and that the insurer wrongly rejected the claim, added the commission.
In addition to ordering the insurer to reimburse the medical costs, the commission asked it to pay an additional Rs 5,000 to the complainant for compensation for moral harassment and legal expenses.
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