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kishen mehta (executive)     28 December 2009

INSURANCE DENIED

 

My father was refused his medical claim by the New India Assurance Company on the pretext of the use of alcohol.
His case was that of a gastric ulcer, which the company cleverly attributed to the intake of alcohol citing the discharge card statement which mentioned that the patient had consumed alcohol (limited to 2 pegs) on a daily basis.
The discharge card clearly stated the consumption of alcohol in the patient’s history column but not as a cause or a probable cause. However the insurance company strictly pointed out that patients with a history of alcohol consumption are known to suffer from ulcers and hence the denial of the claim.
Does this mean to say that all men who consume alcohol on a limited basis within the confines of their home will be refused any medical claim if their ailment can be remotely connected to alcohol?
This claim was held not valid 7 years ago.
Can I get NIAC to recheck the claim and if not can I prevent it from affecting any future claims, now that he has totally given up alcohol.


Learning

 1 Replies

adv. rajeev ( rajoo ) (practicing advocate)     28 December 2009

Frist study the conditions imposed in the policy, if there is nothing regarding refusal of claim if the person is consuming alcohal then issue notice to the company to settle the claim if they refused then file consumer case.


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