Life insurance claim cannot be denied on the ground that patient refused treatment

Punjab and Haryana High Court: An appeal was filed by the Oriental Insurance Company challenging the order of the lower court which had allowed a patient’s family to claim insurance for the death of the patient who had denied taking treatment against medical advice. The patient had met with an accident and he was in a serious condition, said doctors. But he got himself discharged against medical advice and succumbed to his injuries on the day of his discharge itself.

The appellant argued that the insured was already a TB patient with cirrhosis of liver and it could not be predicted that the death was only on account of head injury suffered in the accident and not his pre-existing condition. The doctor testifying for the Insurance Company stated in court that the chances of the recovery couldn’t be ruled out if the patient had stayed on for treatment. The doctor however, not able to assess the prospect of recovery.

The Court examined that between the date of accident and death, there were no other intervening incident that could have affected the medical conditions except that the patient himself denied the treatment which perhaps was available. The cause for death could also be easily discerned from the fact that when he was readmitted, the diagnosis was that there were internal bleeding within the skull and when there was a reference about the general poor condition. Seen in the context of such diagnosis with no reference to the condition of cirrhosis of liver or the tuberculosis which the deceased was said to have already contacted the precipitating factor for the poor condition was only the head injury with internal bleeding within the skull in the brain area. A decision to get discharged even against medical advice at the terminal stage of life shall not be likened to an invitation to assisted suicide. It is embracing dignity in death.

Thus, the High Court dismissing the appeal, approved the payment of the claim. [Oriental Insurance Company Limited v. R.K. Dogra, 2016 SCC OnLine P&H 3397, decided on 18-05-2016]

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