Now Reading: No proof of alcohol link, insurer told to pay Rs 6 lakh claim
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No proof of alcohol link, insurer told to pay Rs 6 lakh claim
The Chandigarh district consumer disputes redressal commission has directed Star Health and Allied Insurance to pay Rs 6 lakh plus 9% annual interest to the family of a deceased policyholder whose liver…
The Story in Brief
The Chandigarh district consumer disputes redressal commission has directed Star Health and Allied Insurance to pay Rs 6 lakh plus 9% annual interest to the family of a deceased policyholder whose liver disease claim was rejected. The insurer had cited an exclusion for alcoholism, but failed to prove that the policyholder’s liver cirrhosis was solely caused by alcohol consumption.
The policyholder, Charanjit Singh, was covered since July 2020 and diagnosed with liver malignancy in March 2022. He died of cardiac arrest in November 2022. PGIMER, Chandigarh, had clarified that his alcohol intake was minimal and his last drink was seven years before treatment. The commission held the repudiation amounted to deficiency in service and unfair trade practice.
The Indian Opinion
Health insurers routinely reject claims by citing exclusion clauses, but this Chandigarh ruling puts the burden of proof where it belongs: on the company. The narrative that every liver disease is alcohol-related is lazy and dangerous. The commission rightly demanded expert evidence, not assumptions. The real test will be whether Star Health appeals or pays up, and whether other insurers now start requiring doctors to document causes more rigorously before denying claims.
Source: hindustantimes.com
This story was synthesised by AI from the source linked above.
