Delhi HC Slaps ₹50,000 Fine On New India Assurance For Unjustly Denying Breast Cancer Patient's Claim

Her ordeal began when she, a stage-IV breast cancer patient, initiated Chemo-immunotherapy, having a total insurance cover of ₹44.5 lakhs under New India Assurance. Despite her legitimate claim, the insurer denied her ₹11 lakh claim, citing the ₹2 lakh sub-limit.

A Bench of Justice Subramonium Prasad said, “Even assuming without admitting, there is an ambiguity, the principle of contra proferentem would be applicable to this case and the Petitioner would be entitled to the entire amount as claimed by the Petitioner.”

Advocate Amit George appeared for the Petitioner and Advocate J.P.N. Shahi appeared for the Respondents.

The insurance company argued that it had already disbursed over ₹37 lakh, but the Court dismissed this as irrelevant to petitioner’s current claim. It mandated compliance with the Ombudsman's award in both letter and spirit.

The Court clarified that there was no ambiguity in the mediclaim policy, emphasizing that the sub-limit of ₹2 lakh applicable to immunotherapy did not extend to Chemo-immunotherapy, a novel treatment blending chemotherapy and immunotherapy.

The Court added, “In view of the fact that the Petitioner, who is a cancer patient, has been harassed without any reason and has been deprived of the amount putting her to mental agony, this Court is inclined to impose costs of Rs.50,000/- on Respondent No.1/Insurance Company to be paid to the Petitioner within four weeks from today.”

Cause Title: Garima Singh v. New India Assurance Co Ltd & Ors., [2024:DHC:3626]

Appearance:

Petitioner: Advocates Amit George, Abraham Mathews, and Adhishwar Suri

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