In a ruling which will lift the spirits of those who drink moderately, the Delhi state Consumer Commission has cautioned insurance companies against the practice of repudiating mediclaim policy of such persons on frivolous grounds.
"Taking alcohol is not an impediment in obtaining an insurance policy and there must be some medical evidence to prove that the insured suffered an infirmity in the near proximity of getting a policy owing to this habit," said Justice J D Kapoor, president of the commission, adding that they (companies) could not repudiate such policies summarily.
"They (companies) are labouring under a misconception and utter ignorance of knowledge that to take liqour in moderation every day was not tantamount to being alcoholic to an extent that one was bound to suffer the consequences of acute liver cirrhosis or the like," the commission said.
The order came on an appeal filed by Oriental Insurance Co Ltd against the order of a District Forum which had asked it to pay Rs 1.19 lakh (Rs 119,000) to one Karan Sehgal,
53, a resident of Shakti Nagar here, whose mediclaim was repudiated on the ground that he was treated owing to his drinking habit.
Dismissing the appeal, Justice Kapoor said if reimbursements to insured will be denied in such a manner then more than 90 per cent population would be out of their net and they (companies) would be rendered out of business in the backdrop of modern day lifestyle.
Sehgal had bought a mediclaim policy for a sum of Rs 2 lakh (Rs 200,000) in October, 2004, for a period of a year.
Later, he was admitted in a city hospital in the same month following complaint of blood vomitting and acute abdomen pain.
After his release, he approached OICL claiming reimbursement of expenses incurred in treatment which was denied on the ground of his medical report which allegedly showed that he was a dipsomaniac for last 20 years.
The company denied payment by invoking exclusion clause.
Citing some international research findings, the Commission said wine and liquor in moderate quantity was healthful for heart and even longevity.
"Insurance companies should change their mindset and should not get bogged down in the old and orthodox views about the drinking habits of the society and the persons living in modern days of stress and strains," the commission said, adding that their record was pathetic in treating such cases as they treat everybody with the same stick.
