Claim Restrictions of Insurance Rejected: Cancer Patient Secures Justice.

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

1 min read: -

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.

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