Legal Question in Insurance Law in India

Re: Claiming Health Insurance

Insurance is a contact and by signing the policy the insurer and the insured are bound by the terms and conditions sated therein. Since it is a general practice of all insurance companies to include the Pre-existing illness clause, it is almost impossible to ask for the compensation for the treatment of diabetes which was pre-existing in the present case.

The only contention that can be raised is that, the treatment was for blisters which were the consequence of walking and not diabetes. Of course the treatment was given for diabetes as well but that was consequential in nature. Primarily the treatment was for blisters and adequate compensation for that should be allowed.

Moreover the clause states that �Acute decomposition of diabetes with the beginning of ulceration & blisters which has arisen due to complications of diabetes� shall not be compensated. If this clause is minutely examined it reveals that the present case should not be affected by it. It is not because of blisters the complication of diabetes has arisen, leading to decomposition of diabetes but it is for the treatment of blisters (which as per the doctors report are due to extensive walking) the process of treatment was initiated and treatment of diabetes was only essential to cure the original problem of blisters which was not at all pre-existing.