If the policyholder discloses the existing medical conditions in the proposal form, the insurer cannot reject a claim citing an existing medical condition. The Supreme Court’s new ruling has brought relief for such insured persons as the insurer cannot reject a claim by citing an existing medical condition disclosed by the insured in the proposal form at the time of the issuance of the policy.
Manmohan Nanda’s overseas mediclaim rejection court case
According to a report, Manmohan Nanda had bought an Overseas Mediclaim Business and Holiday Policy to travel to the United States.
On reaching the San Francisco airport, he suffered a heart attack and was admitted to a hospital, where angioplasty was performed on him, and three stents were inserted to remove the blockage from the heart vessels.
Subsequently, he claimed the treatment expenses from the insurer, which was cancelled by the latter stating that he had a history of hyperlipidaemia and diabetes, which was not disclosed while buying the insurance policy.
However, the apex court said the repudiation of the policy by the United India Insurance company was illegal and not in accordance with the law. The court said the objective of buying a mediclaim policy is to seek indemnification in respect of a sudden illness or sickness that is not expected or imminent and that may occur overseas.
Suppose, the insured suffers a sudden sickness or ailment, not expressly excluded under the policy. In that case, the insurer has a duty to indemnify the appellant for the expenses incurred thereunder.
Amit Chhabra, head health and travel insurance, Policybazaar.com, said that if your policy covers a disease, the insurer has to honour the claim. Besides, if some diseases are not mentioned clearly in the ‘exclusions list’ of the policy document, then in that case also, the insurer will have to pay the claim.
Naval Goel, founder and chief executive, PolicyX.com, said that this is a good step for the policy buyers who buy health insurance to get financial aid during any medical emergency as they rely entirely on the commitments made by their respective health insurers.
Never miss a story! Stay connected and informed with Mint.
our App Now!!