Cancer Patient Secures Justice

Claim Restrictions of Insurance Rejected: Cancer Patient Secures Justice.

Garima Singh v. New India Assurance Co. Ltd. in the Delhi High Court revolves around cancer treatment and insurance claims.

Facts:

1. Diagnosis & Treatment:
   • The petitioner, Garima Singh, was diagnosed with Stage-IV breast cancer in 2021.
   • The cancer spread to the lymph nodes and lungs.
   • She underwent Chemo-immunotherapy, a combination of chemotherapy and immunotherapy.
2. Insurance Claim Dispute:
   • She held a health insurance policy covering Rs. 44.5 lakhs.
   • The insurance company refused to fully reimburse her treatment costs, citing a sub-limit of Rs. 2 lakhs for Monoclonal Antibody injections.
   • The Insurance Ombudsman ruled in her favor, directing the insurer to pay for the treatment.
   • But the insurance company failed to comply with the order.
3. Legal Arguments:
   • The cancer Patient had approached Hon’ble High Court for directing the Insurance company to comply with the order. 
   • The petitioner argued that Chemo-immunotherapy is different from Monoclonal Antibody injections and should not be subjected to the Rs. 2 lakh limit.
   • The court applied the principle of “contra proferentem”, stating that any ambiguity in the policy should be interpreted in favor of the insured.
   • The court held that Chemo-immunotherapy is a modern treatment and should not be restricted by the sub-limit.
4. Final Verdict:
   • The court ordered the insurance company to pay the full amount claimed by the petitioner.
   • The court also imposed a fine of Rs. 50,000 on the insurance company for causing mental agony and harassment to the petitioner.
     
     

Challenges in Cancer Insurance Claims: The case highlights how cancer patients often struggle with insurance companies imposing arbitrary limits on advanced treatments.