Vegetarian policyholder's Rs 1 lakh mediclaim rejected after stroke; insurer said his diet led to B12 deficiency behind the illness; court orders company to pay him Rs 1.1 lakh

A district consumer commission in Ahmedabad has ordered an insurance company to pay a medical claim it had earlier denied on the ground that the policyholder's health complications were caused by vitamin B12 deficiency linked to his vegetarian diet, according to TOI. The commission held that being vegetarian was not the patient's fault, and that the insurer had used a wrong ground to reject a genuine claim.

What happened to the patient

The case involves Meet Thakkar, a resident of Naranpura in Ahmedabad. As per the TOI report, in October 2015, he was admitted to a private hospital for a week after developing giddiness, nausea, heaviness in the left part of his body and general weakness.


Doctors diagnosed him with a transient ischaemic attack, commonly known as a mini stroke. His homocysteine level was recorded at 23.52, well above the normal range of 5 to 15. Thakkar's treatment cost him Rs 1.06 lakh, and since he held a health cover of Rs 5 lakh from New India Assurance Co Ltd, he filed a claim with the company, the TOI report said.

Why the insurer rejected the claim

New India Assurance denied the claim, citing the treating doctor's opinion that Thakkar's high homocysteine levels, a condition known as hyperhomocysteinemia, were caused by vitamin B12 deficiency, and that this deficiency was a result of a lack of dietary supplements. The company invoked the relevant exclusion clause in the policy, arguing that Thakkar's own dietary habits were responsible for his condition, and therefore the claim could not be paid, TOI reported.

This meant a man who had paid for health cover, and who fell seriously ill enough to need a week of hospital care, was told his own food choices were to blame for his bill not being settled.

How the case reached the consumer commission

Thakkar took the matter to the Consumer Dispute Redressal Commission, Ahmedabad District (Additional), represented by advocate Mukesh Parikh of the Consumer Protection and Action Committee. It was argued before the commission that the insurance company had relied on a wrong ground to deny the claim, and had unfairly blamed the patient for a vitamin deficiency that, according to advocate Mukesh Parikh, is very common among people today, reported TOI.

The insurer, for its part, defended its position by relying on various past judgments to support the denial, the TOI noted.

What the commission ruled

After hearing both sides, the commission observed that while vegetarian people may indeed face vitamin B12 deficiency, Thakkar's health complication could not be construed as having been caused by an inadequate diet or as a result of his own fault.

The doctor's own submission, that vegetarians usually suffer from B12 deficiency, had been misinterpreted by the insurance company to refuse the claim, the commission said, as per the TOI report. In effect, the commission found that a general medical observation about vegetarians was being stretched into a reason to deny an individual patient his rightful cover, something the panel did not accept.

The commission directed New India Assurance to pay Thakkar the full Rs 1.06 lakh claim amount, along with 9 percent interest calculated from October 2016. The insurer was also ordered to pay Rs 5,000 as compensation for the mental agony and legal expenses caused to Thakkar.

Inputs from TOI