MUMBAI: The state consumer commission has observed that a patient taking medicine for some time for hypertension and diabetes does not mean suppression of material fact because it is well known fact that hypertension is lifestyle disease and can be controlled by the medicine.
The Maharashtra State Consumer Disputes Redressal Commission upheld a district commission order, directing United India Insurance Company Ltd to refund Rs 5 lakh to Vasant Pai who underwent Multiple Vessle Disease Coronary Angiography and bypass surgery in 2014 but whose claim was repudiated for suppressing a pre existing disease.
The commission in the instant case, the hospital’s discharge summary which merely states that Pai had been taking medicine for hypertension and diabetes which was reportedly normal, was relied upon by the insurance company. “We are of the view that the fact that the patient was taking medicine for some time for hypertension and diabetes does not mean suppression of material fact because it is well known fact that the hypertension is lifestyle disease and can be controlled by the medicine. In the instant case hypertension and diabetes was not so acute or high that it was responsible for the Multiple Vessle Disease Coronary Angiography and Bypass Surgery of the respondent,” the state commission said.
The state commission also said that the district commission has considered the medical papers as well the ratio laid down by national consumer commission in proper perspective. “Insurance company was not justified in repudiating the insurance claim of the respondent (Pai) on the grounds of suppression of material facts as there was no credible evidence filed… to prove that the respondent had undergone treatment for any hypertension related cardiac problems,” the state commission said.
The insurance company had submitted an appeal before the state consumer commission in 2021 after the district commission ruled in favour of Pai in 2020. Pai had moved the district commission in 2016.
Stay updated with the latest news on Times of India. Don't miss daily games like Crossword, Sudoku, and Mini Crossword.Armed with a degree in political science and law, Rebecca Samerve...
Read MoreArmed with a degree in political science and law, Rebecca Samervel waltzed into journalism after a brief stint in modeling. As a reporter at The Times of India, Mumbai, she covers courts. She is a self-confessed food-a-holic. Travelling, politics and television are her passions. If you want to find her during the week the only place to look is the Bombay high court.
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