A district forum has ordered a life insurance company to pay an insured person for his medical expenses on a surgery, which the company had rejected on the grounds that it had the 'probability ' of being a genetic disorder. Ashish Rao, a resident of Ahmedabad, through his counsel Mukesh Parikh, dragged the United India Insurance Company Ltd to the forum after it rejected his claim of Rs 31,667 for surgery he underwent after being diagnosed with Otosclerosis. The condition refers to abnormal growth of bone in the ears causing hearing loss. Rao had a Rs 2 lakh medical insurance from the company. The company rejected his claim of Rs 31,667 on the grounds that the treating doctor had mentioned that the cause of the disease was idiopathic (where the cause is unknown) and hence his disease may have a genetic origin and genetic factors cannot be ruled out. The company during the hearing argued that the complainant had been suffering from the disease for long and had not disclosed it at the time of taking the insurance and it was not admissible on the ground of non-disclosure too. The forum while asking the company to pay up said that the doctor in his discharge papers said he was operated for stapedectomy (a procedure to improve hearing) and that it did not produce any terms and condition of the relevant policy to pinpoint the clause under which it was rejected. It further said that the company failed to explain how the surgery was a result of a genetic disorder and that even the medical papers do not mention idiopathic cause. It further observed that it could be a genetic disorder was more a presumption on the part of the company and it had rejected the claim on the basis of a probability. The forum also asked that the insured be paid Rs 2,000 each towards mental agony and legal expenses.

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