If you have diabetes and hypertension, forget that you can rely on your mediclaim or health insurance policy in emergency, if the policy is not at least four years old.The Gujarat Consumer Dispute Redressal Commission has ruled that if one goes for any surgery within four years of buying an insurance policy and claims refund, it will be considered to be in violation of terms and conditions and the person won’t be entitled to health/medical claim. The commission also set aside an order by the Junagadh forum.”There is an error in the conclusion of the forum in directing the United Insurance Company Limited to pay health claim to complainant Mahendra Vazirani. As per the policy conditions, even though a disclosure is made about diabetes and hypertension, insurance benefits can be extended only after four years,” the commission concluded.It added, “In the present case, the complainant underwent a bypass surgery within two years of buying the health insurance policy. It clearly establishes the violation of the terms and conditions of the policy; so the complainant won’t be entitled to a claim.”The commission’s judicial bench of members VM Chaudhary and MD Gadhvi, while allowing the appeal of the insurance company, opined that there is merit in its submission that diabetes has a direct relationship with hypertension. In support of its contention, it cited the National Commission’s order in LIC vs Srimati Shashi Bala.In this case, complainant Mahendra had subscribed to an individual health policy from the insurance company for 2009-2010. On August 13, 2009, he underwent an angiography, after which he was asked to undergo a bypass surgery. He was operated upon at a Nadiad hospital and he had paid a medical bill of Rs1.20 lakh. As he had a health insurance policy of Rs1 lakh, he said he was entitled to 70 per cent of the insured amount.However, the company rejected his claim citing pre-existing diabetes and hypertension which he had disclosed while buying the policy.An aggrieved Mahendra then approached the Junagadh forum which then asked the insurance company to pay the claim amount. The company challenged the order before the commission.A CONDITIONAL COVERThe Gujarat Consumer Dispute Redressal Commission has ruled that a person who has diabetes and hypertension cannot demand mediclaim refund within 4 yrs of the policy
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