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Gujarat: Insurance Company denies claim for cataract to 7-year-old citing alcohol

There have been instances where insurance companies come up with a huge number of reasons to deny the claim but the reason given by government-run United India insurance company and TPA MD India Health insurance of denying health claim did not go well even with the consumer court.

They rejected the eye treatment claim for a seven-year-old girl stating that she had developed the condition because of using some intoxicated material like drugs and alcohol. Not only this, but they also cited obesity as one of the reasons for the girl developing a cataract. The girl’s father has however spent Rs 62,388 on the treatment.

In July 2016, the girl Hetankshi had undergone removal of a cataract from her both eyes at Baroda Children Eye Care and Squint Clinic. The insurance company has however rejected the claim sighting conditions of the mediclaim policy. As per the policies condition, treatment of ailments caused due to intoxicating material like drug or alcohol, obesity or intentional self-injury are not covered.

A case was filed by the girl’s father Gopal Devpura against the insurance company and TPA at Vadodara District disputes redressal forum for seeking reimbursement of the medical cost.

The forum upheld the arguments that the cataract was not developed due to alcohol, drugs or obesity as the company failed to produce any document supporting their arguments. Also, they observed that the insurance company misinterpreted the condition of the policy to not pay the money.

Also, the court ordered the companies to reimburse Rs 62,236 as treatment cost along with 8% interest and compensation of Rs 3,500.

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