In Brief
A son underwent extended treatment at a medical institute, incurring bills of over Rs.8.5 lakh. His father had continuously held individual mediclaim policies for him since 2007 and switched to a family mediclaim policy in 2014 with a sum insured of Rs.5 lakh. The insurance company initially repudiated the claim citing pre-existing disease, then partially paid Rs.27,550. The National Commission awarded 50% of the 2010-2011 individual policy sum. The Supreme Court held the insurer was entitled to claim only 50% of the family sum insured (Rs.2.5 lakh) per illness, and the pre-existing disease defence was unavailable since the policy had been continuously renewed without exclusion. The insurer was directed to pay the balance amount, plus compensation for mental agony and litigation costs.
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