From Financialexpress · FE News Desk · · 1m 50s
Chandigarh commission awards Rs 19.2 lakh for liver transplant claims
Chandigarh consumer commission orders insurer to pay Rs 19.2 lakh after rejecting liver transplant claims due to alcohol exclusion.
In brief
Chandigarh consumer commission orders insurer to pay Rs 19.2 lakh after rejecting liver transplant claims due to alcohol exclusion. A Chandigarh consumer commission ruled an insurer must pay Rs 19.2 lakh to a man whose liver transplant claims were rejected for alcoholism-related treatment. Originally reported by…
Liver transplant claims rejected
A Chandigarh consumer commission directed an insurer to pay Rs 18.7 lakh, interest, and Rs 50,000 compensation to a Mohali man whose liver transplant claims were rejected due to alcohol exclusion.
Policyholder's medical history
The man had been diagnosed with alcoholic liver disease in November 2023 and decompensated cirrhosis, but medical records showed his chronic liver disease was diagnosed for the first time.
Insurer's rejection reason
The insurer argued the man's liver transplant and hospitalisations were direct consequences of alcohol-related conditions covered by the policy's permanent exclusion clause.
Commission's findings
The commission found the insurer failed to prove the man had received previous treatment for chronic liver disease or submitted claims for alcoholism-related conditions.
Medical complications
The husband was hospitalised twice for post-transplant complications, once in 2024 and again in 2025, with the insurer rejecting these claims under the same exclusion.
Commission order
The commission ordered the insurer to pay Rs 18.7 lakh, interest, and Rs 50,000 for mental agony and litigation costs, totaling Rs 19.2 lakh.
Policy duration
The man held the health insurance policy since 2018, with coverage including Rs 10 lakh sum insured and Rs 6 lakh loyalty benefit for the 2024-25 policy period.
Commission's ruling
The commission held the case did not fall under the permanent exclusion clause because the insurer could not prove the man had previously received treatment for chronic liver disease.
In short
A Chandigarh consumer commission ruled an insurer must pay Rs 19.2 lakh to a man whose liver transplant claims were rejected for alcoholism-related treatment.
