09 Nov 2018: Consumer Forum: Alcohol in limited quantity isn't poison, but sugar-content
A Chandigarh Consumer Forum observed alcohol taken in limited quantity wasn't poison but sugar content while directing insurance companies to pay Rs. 1.93 lakh to a Mohali resident.
The forum also noted pancreatitis has no relation with intake of alcohol.
The insurance companies claimed the man, Sarbjit Singh Kahlon, fell ill due to alcohol consumption and that isn't covered in their policies.
The case: For 27 years, Kahlon and his wife continued mediclaim policy
Kahlon and his wife had been continuing with their mediclaim policy for 27 years. On June 20, 2017, an abdominal pain made him uneasy and he was taken to Hope Clinic.
There the doctors referred him to Fortis Hospital, and on the same day, he was admitted to CCU under the gastro department for treatment.
His son informed insurance companies about it.
Claims denied: Kahlon's claim was rejected by companies
The companies New India Assurance Company and Raksha Health Insurance rejected the cashless facilities, and on June 26 Kahlon was discharged.
The family paid Rs. 1.58 lakh to the hospital.
Later, Kahlon's kin went to Raksha Health Insurance with all the documents and was rejected again.
Meanwhile, Kahlon was re-admitted to Max Hospital on August 3 and was discharged after a gall bladder operation.
Next step: Upset with rejection, Kahlon went to consumer forum
This time around when Kahlon raised the bills of the operation, his claim was denied. Raksha Health Insurance, however, paid him just Rs. 31,729. He then knocked on the doors of consumer forum.
In a reply, New India Assurance Company Limited said Kahlon had a history of acute pancreatitis.
It cited reports of Holy Clinic which showed he took alcohol a day before hospitalization.
The defense: Companies claim alcohol-related diseases weren't covered and Kahlon knew it
The company claimed alcohol-related diseases weren't covered under the scheme and argued Kahlon knew of it.
On the other hand, Raksha Health Insurance said they agreed with the reply filed by New India Assurance Company.
But their arguments fell flat in court. In its verdict on November 6, it noted hypertension wasn't a disease in itself and blood pressure increased or decreased with age.
Fact: Forum notes alcohol could not have caused the illness
"Alcohol in itself is not a poison if taken in small quantity as it is a mixture of water, sugar and fermenting agent. In other words, it is a sugar content and, if taken in a limit, it cannot be said he was an alcoholic or it could have caused pancreatitis," the judgment read.
The order: Insurance companies ordered to pay money to complainant
The court ordered the insurance companies to pay Rs. 1,58,025 towards the claim of a medical bill at Fortis Hospital, and an interest of 9% per annum.
Further, the court directed the companies to pay Rs. 25,000 to Kohlan as compensation and Rs. 10,000 as litigation charges.
The court opined it was a case of deficiency on part of insurance companies.