Page 131 - Suri’s - NCDRC ON LIFE INSURANCE 2017 V1.3

Suri’s - NCDRC ON LIFE INSURANCE 2017 131

INDEX

(click to follow links to judgements)

Critical Illness - When the contents of the discharge summaries are seen

against the requirements of what constitutes a CRITICAL ILL-
NESS under the policy, it becomes quite clear that the petitioner

complainant‘s case cannot be called a case of critical illness -

This does not mean that his illness or treatment was not real or
not important - It only means that his claim under critical illness

category cannot be sustained. ...108
Critical illness policy - Angioplasty - Critical benefit clause in the insur-

ance policy, came to the conclusion that Angioplasty was not
covered as an additional benefit under the critical illness benefit -

On reading of clause (B) of the note defining critical illness, so

far as heart ailment is concerned, critical illness benefit has been
extended under the policy for critical coronary heart by-pass graft

surgery and the clause specifically provides that balloon angio-
plasty, laser or any catheter based procedures are not covered un-

der the critical illness benefit. ...33
Diabetes Mellitus - Contention that even if the insured was suffering

from Diabetes Mellitus, it had no nexus with the heart problem

which was cause of the death - We do not find merit in this con-
tention - As per medical science, Diabetes is a killer disease and

if not properly controlled and cured it can result in hyper tension

as also lead to heart problem or failure of other organs. ...101

INDEX