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Health insurer told to pay
Jyotirmoy Mazumdar

Calcutta, March 18: A consumer court has ordered a private insurance firm to pay the reimbursement claim made by a 65-year-old man who was operated on for cancer.

Jyotirmoy Mazumdar is being denied Rs 2 lakh since 2005, when he underwent the surgery for cancer in the rectum, on the ground that the ailment was related to colon cancer he was diagnosed with before taking out the policy.

Oncologists who submitted their opinion before the Consumer Disputes Redressal Forum, however, refuted Royal Sundaram Alliance Insurance’s claim, saying the earlier cancer had been cured.

“If a cancer does not recur in five years, it’s assumed to be cured,” said surgical oncologist Gautam Mukhopadhyay, who was not among those who deposed before the court. According to Mazumdar’s doctors, he has never suffered any symptom of colon cancer since an operation in 1992.

“I took out a health insurance of Rs 2 lakh from Royal Sundaram in early 2005. I was diagnosed with rectal cancer in September that year and was operated on the next month. But when I claimed the money, the company refused on the ground that the ailment was pre-existing,” said Mazumdar, a resident of Kasba.

Contesting Mazumdar’s petition, the firm submitted before the court: “Pre-existing conditions also mean sickness or symptoms which existed prior to the date of this insurance.” But the court rejected the argument after hearing out experts, who stated that the rectal cancer was not linked to the earlier colon cancer, and ordered the firm to pay Rs 2 lakh to Mazumdar.

When contacted by The Telegraph, a Royal Sundaram spokesperson refused to comment.

Hospitals and doctors have reported several other cases similar to Mazumdar’s. In one such case, the family of a 69-year-old woman (name withheld on request), who would undergo an operation for rectal cancer soon, is still not sure whether the insurance firm would repay the policy.

“The firm is trying to link the ailment with the colon cancer she had been diagnosed with in 2000 and was cured of,” said a relative.

Sources in the insurance sector said around 10 per cent of the claims were rejected, mostly because of the “pre-existing” clause. Hospitals give a higher figure.

“Only 30 per cent of the claims are reimbursed,” said Sudipta Mitra, the medical superintendent of Peerless Hospital. Cardiac patients, too, face problems.

“Diabetes and congenital heart diseases, which patients are mostly unaware of, are often cited as reasons for refusal. Insurance firms should be less rigid,” said cardiac surgeon Kunal Sarkar.

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