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Dec 8 2011 10:40AM
Diabetic wins mediclaim 10 years after losing foot

The South Mumbai District Consumer Disputes Redressal Forum last week ordered an insurance company to pay almost Rs 5.5 lakh to a Worli resident after his doctor mistakenly recorded that he was suffering from diabetes for 15 years instead of just 15 days. The insurance company had repudiated the patients claim around seven years ago even after the doctor sent another letter correcting the error. The forum which held United India Insurance guilty for deficiency of service, observed, There is no evidence prior to 2001, (that) the complainant (Kanhaiyalal Ruia) had taken medical treatment for his diabetes.It went on to say that the companys refusal to meet the claim amount was without any basis and illegal. The insurance company will pay Ruia almost Rs.5.5 lakh with 9% interest from November 2003 till the entire amount is received by him. Additionally, Ruia will also receive Rs 5,000 for mental agony and harassment and Rs 3,000 towards cost of the proceedings. In the complaint filed before the forum on October 5, 2005, Ruia stated that in 2001 he enjoyed good health. In August 2001 however, his wife was operated upon for an oral malignancy. During the period of his wifes hospitalization, Ruia noticed an injury on his left toe, which he attributed to a shoe bite. More concerned about his wifes illness, he took his injury lightly and applied an ointment, but it did not heal fully. When he finally consulted a physician, it was found that Ruias blood sugar was high and this was attributed to the extreme mental stress and trauma he was undergoing because of his wifes health. Despite taking the prescribed medication, Ruias toe wound did not heal. Three months later, there was still no improvement. In fact, the wound had become infected and pus was oozing out. After conducting extensive tests, Ruia was admitted to hospital on December 17, 2001, and two days later doctors amputated his left toe. Ruia was operated for the third time in February 2002 when his left foot was amputated. The doctor, however, made an error while filling in the medical insurance form, and stated that the patient was diabetic for 15 years instead of 15 days prior to the report being filed. Records show that Ruia had learnt that he had diabetes on December 15, 2001-four months after the injury.The doctor explained that he had misunderstood Ruia. As the complainants foot was amputated, he thought that he was suffering from diabetes since last 15 years and accordingly he made the noting. Later on he realized that he had totally misunderstood the situation, and immediately issued a corrigendum and corrected his mistake,the forum observed. While rejecting the claim, the insurance company presumed that Ruia was suffering from diabetes for the last 15 years and he had not disclosed this in the policy form. Even after Ruias doctor sent the insurance company a second letter clearly stating that there was an error in prescription and it should have been 15 days instead of 15 years, the insurance company did not reconsider the claim. After repeated requests to reconsider his claim, the company finally rejected it in November 2003. Ruia then filed the complaint in the consumer forum after which the insurance company filed its reply and denied Ruias allegations. The company argued that diabetic foot is a well-known and widely-accepted complication arising out of diabetes. It alleged that Ruia had deliberately concealed his condition at the time of obtaining the mediclaim policy form. Ruia had taken the mediclaim policy from the insurance company in 1994. The forum ruled in favour of Ruia.
 
 
 
 
 
 
 
 
 
     
 
     
 
 
 
 
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