Insurance Firm Denies Cancer Claim Over Child’s Speech Delay, Must Pay Rs 20 Lakh

The Maharashtra State Consumer Disputes Redressal Commission has directed Apollo Munich Health Insurance Company Limited to pay Rs 20 lakh to a man whose son died of blood cancer. The insurance company had earlier rejected the claim, citing a ‘speech delay’ in the child’s early developmental years.

The commission, in its order dated July 2, described the insurance company’s action as “arbitrary”, “legally untenable”, and “malicious”. It stated that using a minor childhood developmental issue to avoid paying a genuine insurance claim during a family’s medical crisis amounted to an unfair trade practice.

The complaint was filed by a doctor whose son was diagnosed with blood cancer. The family spent over Rs 33 lakh on treatment. Despite having a valid medi-claim policy, Apollo Munich refused to cover the expenses and later cancelled the policy, citing non-disclosure of the child’s temporary speech delay, which had occurred years earlier and had resolved without intervention.

The commission noted that the speech delay was a minor, temporary condition unrelated to the cancer. It held that the insurance company violated the doctrine of utmost good faith by using this pretext to deny the claim. The order also criticised the unilateral termination of the policy without proper justification.

This ruling reinforces consumer protection in insurance disputes, emphasising that insurers cannot reject claims based on trivial or unrelated pre-existing conditions. The commission awarded Rs 20 lakh as compensation, along with interest and costs.