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Alcohol not poison if taken in small dose, says consumer forum

November 09, 2018 06:04 AM

COURTESY TOI NOV 9

Alcohol not poison if taken in small dose, says consumer forum
Ajay.Sura@timesgroup.com

Chandigarh:

In an order with huge ramifications, especially in cases related to medical insurance claims, a consumer forum in Chandigarh has held that mediclaim cannot be denied just because the patient had consumed alcohol before admission to hospital for treatment. The forum also observed that “alcohol in itself is not a poison, if taken in small quantity as it is admixture of water, sugar, and fermenting agent.”


The consumer forum also directed New India Assurance Company Limited to pay Rs 1.58 lakh as medical reimbursement to Mohali resident Sarbjit Singh Kahlon, who was denied payment on the ground that he had consumed alcohol before being admitted to hospital for treatment.

The division bench of the District Consumer Redressal Forum-I Chandigarh, comprising its president Rattan Singh Thakur and member Suresh Kumar Sardana, passed these orders on Kahlon’s complaint.

Kahlon had obtained a mediclaim policy from the New India Assurance Company Limited. On June 20, 2017, he felt uneasy on account of abdominal pain and was taken to a clinic from where he was referred to Mohali’s Fortis Hospital and admitted to the gastro department’s CCU.

The insurance firm denied Kahlon cashless facility and he was discharged after he made a payment of Rs 1.58 lakh.

The complainant took up the matter with Raksha Health Insurance TPA Pvt. Limited along with all the medical records and reports of his hospitalisation, but his claim was denied again. Finally, he moved the consumer forum, alleging deficiency in service.

Pancreatitis admittedly has no nexus with the intake of alcohol: Forum

Contesting his claim, the firm submitted that Kahlon was admitted to Fortis with a complaint of acute abdominal pain. Kahlon, it added, had a history of acute pancreatic problem along with hypertension.

The doctor’s prescription from nursing home had a notation that Kahlon had taken ‘ethanol’ a day before hospitalization and it argued that alcohol is the main factor in pancreatic issues. It also argued that any ailment or its complication that arises due to alcohol is permanently excluded from the scope of policy.

The forum scrutinized the medical record to determine if consumption of alcohol a day earlier had any connection with Kahlon’s ailment.

The forum found that the doctors had made a reference to the history of the complainant taking alcohol a day earlier, but, did not mention whether the quantity of alcohol consumed was on the higher side, which could have led to his ailment.

“Pancreatitis admittedly has no nexus with the intake of alcohol. Therefore, much credence could not have been attached to the stray sentences written in the medical history of the complainant by the doctor regarding intake of alcohol,” observed the forum.

“Alcohol in itself is not a poison, if taken in small quantity as it is admixture of water, sugar and fermenting agent. In other words, it is a sugar content and, if taken in limit, it cannot be said he was an alcoholic or it could have caused pancreatitis,” it held.

The forum also directed the insurance company to pay around Rs 1.58 lakh towards claim of the medical bill at Fortis and Rs 35,000 to the complainant as compensation for mental agony and harassment and litigation cost.

 

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