Menstruation can't be classified as Disease: Consumer Court holds Insurance Company Liable

Malappuram: Holding Star Health & Allied Insurance Company Limited liable for deficiency in service for refusing a health insurance claim to a patient by classifying menstruation as a disease, the Malappuram District Consumer Disputes Redressal Commission has asked them to pay Rs 1,07,027 for medical expenses, Rs 50,000 as compensation to her and Rs 10,000 for legal costs.  

The health insurance claim was denied on the grounds that the patient had consulted a doctor for excessive menstrual bleeding in 2018, five years before the current treatment. The insurance company argued that this information was not disclosed when the policy was purchased, rendering the claim invalid.

Criticising the company for its stance, the commission presided over by Sri. Mohandasan K( President) , Smt.Preethi Sivaraman C (Member), Sri. Mohamed Ismayil C.V. ( Member) deemed it unreasonable to consider excessive menstrual bleeding a disease requiring prior disclosure. It ruled that the denial amounted to a deficiency in service.

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The ruling was issued in response to a complaint filed by Naduvath resident Subrahmanian regarding his wife's medical expenses. Subrahmanian had been maintaining a health insurance policy for his family since 2020. In June 2023, his wife was admitted to a private hospital in Wandoor for treatment.

When his wife required hospital treatment, the insurer initially indicated approval of Rs 1,07,027 based on hospital records. However, the claim was later denied after the company reviewed the documents. 

Citing that a past medical consultation was made in 2018 for excessive menstrual bleeding and the matter was not reported to the company before purchasing the policy, the firm denied the health insurance claim. 

Rejecting the insurer's arguments, the commission ruled that the past consultation was unrelated to the 2023 hospitalization. The commission stated that excessive menstrual bleeding should not be considered a disease. Therefore, it criticised the company's stance, deeming it unreasonable to consider excessive menstrual bleeding a disease requiring prior disclosure. The commission ruled that the denial amounted to a deficiency in service.

As per the ruling, the insurance company has been directed to pay Rs 1,07,027 for medical expenses, ₹50,000 in compensation, and ₹10,000 in legal costs, reports Onmanorama. Additionally, failure to comply within a month will attract a 12 per cent annual interest on the amount from the date of judgment. 

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