Justice Subramonium Prasad said that there is no ambiguity in the mediclaim policy and the sub-limit of ₹2 lakh which is applicable to immunotherapy does not apply to Chemo-immunotherapy, a new form of treatment which is a combination of chemotherapy and immunotherapy.
“Even assuming without admitting, there is an ambiguity, the principle of contra proferentem would be applicable to this case and the petitioner would be entitled to the entire amount as claimed,” the Court said.
It, therefore, ordered the insurance company to clear the claim of petitioner Garima Singh who had been receiving treatment for breast cancer which later spread to her lymph nodes and to both the lungs.
“Accordingly, the writ petition is allowed with a direction to the Insurance Company to clear the claim of the petitioner within four weeks from today. In view of the fact that the petitioner, who is a cancer patient, has been harassed without any reason and has been deprived of the amount putting her to mental agony, this Court is inclined to impose costs of ₹50,000/- on Respondent No.1/Insurance Company to be paid to the petitioner within four weeks from today,” the Court stated.
Source: Barandbench
