Insurer ordered to pay for mucormycosis treatment of Gandhinagar resident, told BP not a cause

AHMEDABAD: The Gujarat State Consumer Dispute Redressal Commission has upheld an order to an insurance company to pay for the treatment of mucormycosis, which the company denied saying that the patient had hidden the fact that he was suffering from hypertension while obtaining the policy.

While ordering the company to pay for the treatment, the commission said, "Hypertension is a lifetime disease, can be managed by proper medication and it is not the root cause for mucormycosis. Mucormycosis is a by-product of Covid-19. It is not proven that persons having hypertension got Covid-19." The commission also said that the insurer cannot run away from its liability by raising "such flimsy grounds".

The case involved a Gandhinagar resident, Amrut Patel, 68. He fell ill due to Covid and was hospitalized in April 2021.

'No intent of patient to hide information established'
A few days after Amrut Patel's discharge from the hospital, he experienced pain in his ears. He was diagnosed with mucormycosis and hospitalized again. He incurred Rs 7.52 lakh on treatment and claimed reimbursement from Reliance General Insurance Co, from which he had taken a health cover.

Patel's claim was rejected on the ground that he was suffering from hypertension for the past 20 years, but did not disclose the pre-existing disease. Patel approached the Gandhinagar district's consumer commission, which ordered the insurer to pay the claim amount. The company appealed against the order reiterating its stand that the patient suppressed information about having hypertension, and it's a violation of mediclaim policy.

The state commission did not agree with the company's contentions and said that Patel had no knowledge of having the disease, because while obtaining the policy, he had disclosed high cholesterol level as pre-existing disease. There was no reason behind hiding information about other diseases. It said that the company could not establish the patient's intention to hide information about his disease.