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

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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