GARIMA SINGH Vs. NEW INDIA ASSURANCE CO LTD.

JUDGEMENT

(1.) Petitioner has filed the present Writ Petition with the following prayers:

(2.) It is stated that the Petitioner purchased a medi-claim Policy from Respondent No.1 herein with a cover of Rs.15.00 Lakhs and over time, since the Petitioner did not make any claim the policy amount was increased to Rs.22.5 lakhs. It is stated that in 2015, the Petitioner purchased a top up policy of Rs.22.00 lakhs, thereby, increasing the total cover under the Policy to Rs.44.5 lakhs. It is stated that in 2021 the Petitioner was diagnosed with Stage-IV breast cancer, which, at present, has spread from the primary organ, i.e. breast, to lymph nodes and to both the lungs of the Petitioner. It is stated that the Petitioner is undergoing Chemo-immunotherapy for the treatment of the disease. It is stated that the Petitioner made a claim under the Insurance Policy and the same was denied by the Insurer on the ground that the claim made by the Petitioner exceeds the terms of the Policy inasmuch as a claim for treatment for giving Monoclonal Antibody injections, cannot exceed Rs.2.00 Lakhs.

(3.) Aggrieved by the said decision of the Insurer, the Petitioner filed a complaint to the Insurance Ombudsman claiming an amount of Rs.11.00 Lakhs for the cost of treatment undergone by the Petitioner. The Insurance Ombudsman vide Order dtd. 13/1/2023, after considering the case, directed the Insurer to settle the claims of the Petitioner as a precious life is being saved by such medical treatment as needed and as advised by the Doctor. The Award passed by the Insurance Ombudsman reads as under: