State Consumer Commission Decision:
The state consumer commission ruled against Oriental Insurance Co Ltd (OICL) for rejecting a mediclaim based on non-disclosure of pre-existing conditions, including diabetes mellitus (DM) and coronary artery disease. The commission upheld the complainant’s argument, referencing a national consumer commission decision that deemed diabetes a lifestyle disease, too prevalent to justify denying an insurance claim entirely.
Case Background:
Anshul Garg purchased a Rs 2 lakh mediclaim policy in 2013. In 2014, his father underwent cardiac surgery costing Rs 5 lakh. Garg’s claim was denied by OICL, leading him to approach the consumer court. The district consumer commission ruled in favor of Garg, ordering OICL to pay Rs 2 lakh plus interest and litigation expenses. OICL appealed the decision.
Commission’s Findings:
The state commission found no credible evidence from OICL to support their claim of concealment of pre-existing illness. The commission noted that OICL failed to prove that Garg’s father had diabetes for 15 years, which allegedly caused the coronary artery blockage.
