Case Study 33 - RSA Rejected claim saying it's Pre-existing Heart disease along with Hypertension

Mr. Ahuja is having Health Insurance from Royal Sundaram. He was diagnosed with CAD angina, for which he had to undergo Coronary Angiography and Angioplasty, which was informed to company with proper procedure. But company rejected the claim on the ground that complainant was known case of Hypertension since 2000. On explanation by the customer company replied that the complainant concealed the fact that he suffered from Heart disease along with Hypertension since the year 2000, which is specifically excluded under policy terms.

Consumer Forum judgment: It cannot be said if the complainant was suffering from Hypertension nor can it be said that he concealed the disease at the time of purchasing the policy.” Needless to mention that CAD is totally different disease than hypertension. The claim for CAD therefore cannot be repudiated on the ground that the complainant was suffering from Hypertension. We appreciate this judgment as it has been customary for the insurance companies to reject the claim on the basis by taking the lea of hypertension.