Indian court rules health cover cannot be denied over alcohol intake

Insurer couldn’t prove that complainant was an alcoholic, decision says

Indian court rules health cover cannot be denied over alcohol intake

Insurance News

By Gabriel Olano

An Indian consumer court has ruled that moderate consumption of alcohol prior to hospitalisation cannot be used as grounds to deny medical insurance.

The Chandigarh Consumer Forum directed New India Assurance Company to reimburse complainant Sarbjit Singh Kahlon INR158,000 (US$2,170) in medical expenses after the insurer denied his health insurance claim, The Indian Express reported. The rejection was on the grounds of Kahlon having consumed alcohol a day before being hospitalised for acute abdominal pain.

Kahlon said that he and his wife had held the health insurance policy for over 27 years. In June 2017, he felt abdominal pain and was taken to a clinic before being referred to a hospital. However, due to the complainant’s alcohol intake, the insurer rejected his cashless facility, and he was only discharged after his family paid out-of-pocket.

In its response, New India Assurance Company said Kahlon had a history of acute pancreatitis, and argued that he knew that alcohol-related diseases were not covered by the policy.

However, the court did not accept the insurer’s argument and sided with the complainant, saying that it could not be proved that Kahlon’s alcohol consumption the day before he was hospitalised was behind the illness.

According to the decision, “alcohol in itself is not poison if taken in a small quantity… if taken within limit, it cannot be said [the complainant] was an alcoholic or it could have caused pancreatitis.”

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