Archive · 3 Nov 2025
Insurance Firm Ordered to Pay Rs 3.18 Lakh Plus Interest for Denying Cancer Claim
An insurance company refused to pay for a man's cancer treatment, saying it was because he chewed betelnut.
His wife, who is the beneficiary, took the insurance company to court.
The court looked at the insurance rules and the evidence.
The insurance company only had a doctor's note saying the man chewed betelnut.
They didn't bring the doctor to court to explain if this habit directly caused the cancer and if it was a reason to deny coverage according to the policy.
The court decided that the insurance company didn't prove their reason was valid.
They ordered the insurance company to pay the full treatment cost, plus interest, and also give some money for the trouble caused.
An insurance firm was ordered to pay Rs 3.18 lakh plus interest for denying a cancer treatment claim.
The insurer cited the patient's betelnut chewing habit as the reason for denial.
The Chandigarh Consumer Disputes Redressal Commission ruled that the insurer lacked sufficient proof to link the habit to cancer under policy exclusions.
The commission criticized insurers for selling policies with 'green pastures' but finding excuses to reject claims.
The insurance company must also pay Rs 20,000 as compensation for harassment and litigation expenses.
- Who
- Chandigarh Consumer Disputes Redressal Commission, Cigna TTK Health Insurance Company Limited, and the widow of the insured, Amarjeet Kaur Walia.
- What
- The commission directed the insurance company to pay Rs 3.18 lakh with interest and compensation for denying a cancer treatment claim.
- When
- The claim was rejected on June 27, 2020. The treatment occurred in January 2020. The commission's directive date is not specified.
- Where
- Chandigarh, India
- Why
- The insurance company rejected the claim citing the patient's betelnut chewing habit. The commission found the rejection unjustified, stating the insurer failed to provide sufficient proof from the treating doctor to link the habit to the cancer under policy exclusions.
Consumer (Widow of Insured)
Insurance Company (Cigna TTK)
Basis for Claim Rejection
Consumer (Widow of Insured)
The claim was for legitimate cancer treatment and should be reimbursed as per the policy.
Insurance Company (Cigna TTK)
The policy's exclusion clause regarding substance abuse/consequences applies, as the insured had a history of betelnut chewing which may have led to the ailment.
Evidence of Policy Exclusion
Consumer (Widow of Insured)
The insurance company failed to provide sufficient evidence, such as an affidavit or testimony from the treating doctor, to prove that the betelnut chewing habit caused the cancer and fell under the policy's permanent exclusions.
Insurance Company (Cigna TTK)
A prescription slip dated January 6, 2020, established the patient's history of betelnut chewing, sufficient to invoke policy exclusions.
Insurer's Conduct
Consumer (Widow of Insured)
The insurer used technicalities and common excuses to deny a valid claim, despite showing 'green pastures' when selling the policy.
Insurance Company (Cigna TTK)
The insurer acted in accordance with the terms and conditions of the policy by rejecting a claim that did not meet the coverage criteria.
- Insurance Company
- Cigna TTK Health Insurance Company Limited
- Policy Holder
- Gurnam Singh Walia (deceased)
- Sum Assured
- Rs 4,50,000
- Treatment Dates
- January 7, 2020 - January 10, 2020
- Diagnosis
- Carcinoma Right Buccal Mucosa
- Claim Amount Sought
- Rs 3,55,304
- Claim Rejection Date
- June 27, 2020
- Commission Order Date
- Not specified in article