Booze before hospitalisation no ground for mediclaim denial

CHANDIGARH: A consumer court in Chandigarh has held that medical insurance cannot be denied just because the patient had consumed alcohol before his admission to hospital for treatment.

The forum observed that "alcohol in itself is not poison if taken in a small quantity. As it is admixture of water, sugar, and fermenting agent... if taken within limit, it cannot be said he (the complainant) was an alcoholic or it could have caused pancreatitis."

The consumer protection panel directed New India Assurance Company to pay around 1.58 lakh as medical reimbursement to complainant, Mohali-resident Sarbjit Singh Kahlon, who was denied payment on grounds that he had consumed alcohol before being hospitalized with acute abdominal pain.

The division bench of district consumer redressal forum-I Chandigarh, comprising its president Rattan Singh Thakur and member Suresh Kumar Sardana, said, "Pancreatitis admittedly has no nexus with the intake of alcohol. Thus, much credence could not have been attached to the stray sentences written in the complainant's medical history by the doctor regarding intake of alcohol."

Kahlon had obtained a mediclaim policy from the New India Assurance. On June 20, 2017, he felt uneasy with abdominal pain and was taken to a nursing home from where he was referred to the Fortis Hospital at Mohali and admitted to a critical care unit of the gastro department.

The insurance firm had denied Kahlon cashless facility. He was discharged after he paid 1.58 lakh.