on Oct 02, 2021)AHMEDABAD: A consumer court here has ordered an insurance company to reimburse the expenditure on medical treatment for lung cancer after the company refused mediclaim on the grounds that the patient was a chain smoker and contracted cancer due to his smoking. The consumer court said there was no proof that the cancer had been caused by the patient’s smoking habit.
The case involved one Alok Kumar Banerjee from Thaltej, who underwent treatment for adenocarcinoma of the lung from Vedanta Institute of Medical Science in July 2014 and incurred a medical bill of Rs 93,297. He had medical insurance cover. But his claim was rejected by the insurer.
After Banerjee passed away, his widow Smita sued the insurer in 2016 in the Consumer Dispute Redressal Commission, Ahmedabad (additional), where the insurance company took the defence that Banerjee was treated in different hospitals for his illness, which had a direct nexus with his smoking habit, and that this was reflected in his case papers.
The consumer commission did not agree. It cited a higher forum’s order and said that a discharge summary itself cannot be treated as primary or conclusive evidence in the absence of any independent proof. There was no evidence in this case to show that the patient got cancer because of smoking.
The insurance company’s doctor gave a medical opinion that those who smoke have a 26 times higher risk of getting cancer. To this, the commission said that merely on the basis of this opinion it cannot be concluded that the patient got cancer due to his smoking habit. Those who do not smoke also get lung cancer and it cannot be believed that all those who smoke have lung cancer. It cannot be accepted that the complainant’s husband got cancer because of his smoking habit and the insurer had wrongly rejected the claim, the commission added.
Besides ordering the insurer to refund the medical expense, the commission has asked it to pay Rs 5,000 extra to the complainant towards compensation for mental harassment and legal expenditure.
