Vadodara: A Dahod consumer forum observed that as the word ‘tobacco’ wasn’t mentioned in the policy clause, the insurance company couldn’t reject the claim for treatment of an oral cancer patient. The insurer was ordered to pay the full claim amount to the deceased’s heirs.According to the case details, Ramchandra Pamnani was diagnosed with oral cancer and admitted to a hospital in Ahmedabad for treatment. The treatment cost Rs 13.21 lakh after which an insurance claim was filed with United Insurance Company Ltd. The insurer paid Rs 2.33 lakh and denied the rest by arguing that the patient suffered from cancer due to tobacco use.Pamnani’s family then filed a complaint in the Dahod district consumer disputes redressal commission in 2021. The insurer produced certificates for Pamnani’s treatment and medical opinions from two hospitals but didn’t submit affidavits of the doctors who treated him. The policy clause mentioned intentional drugs/alcohol in the clause for the claim rejection.The consumer forum heard both sides and observed that the policy clause didn’t mention tobacco anywhere and the complainant was entitled to get the sum assured. The consumer commission ordered the insurer to pay Rs 7.66 lakh to the complainant’s heirs within two months of the order. The insurer was also been ordered to pay Rs 2,000 each for legal costs and mental trauma caused to the complainants.
