₹5L claim denied over waiting period: Wife won
A Mumbai consumer court has ruled that a health insurance company must pay a ₹5 lakh claim for a pancreatitis patient who died shortly after being hospitalized. The insurer, Max Bupa Health Insurance Co. Ltd., had rejected the claim citing a 24-month waiting period for pancreatitis, arguing it was a pre-existing condition. However, the court held that the insurer could not rely solely on the waiting period clause to deny coverage.
The court found that the insurer had failed to prove the pancreatitis existed before the policy was taken out and that it was not a pre-existing condition. The insurer was directed to pay the claim.
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