The commission said 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. (Image generated using AI)The Maharashtra State Consumer Disputes Redressal Commission has ordered a private insurance company to pay Rs 20 lakh to a man whose son died of blood cancer and was reportedly refused the money over the child’s “speech delay” during his developing years. The commission called the action of the insurance company “arbitrary” and “legally untenable”.Presiding Member Poonam V Maharshi and Member Dr Nisha Amol Chavhan were hearing a complaint filed by a doctor against Apollo Munich Health Insurance Company Limited over the rejection of his insurance claim and cancellation of his family’s medi-claim policy.“The grounds on which the Insurance Company repudiated the Complainant’s initial claim and unilaterally terminated the medical policy are completely arbitrary, legally untenable, and malicious. The Opposite Parties (Apollo Munich Health Insurance Company Limited) have placed primary reliance on the non-disclosure of a temporary ‘speech delay’ in the child’s early developmental years to claim a breach of the utmost good faith doctrine,” the commission held on July 2.The body further opined that a developmental speech delay in a growing child was “an ordinary physiological milestone variance” which was neither a chronic disease, a pre-existing medical deformity, nor a material fact, mandating a declaration under a standard health proposal form.The dispute arose after the insurer rejected the doctor’s claim in May 2017 and cancelled the policy, leaving the family to bear the cost of prolonged cancer treatment before the child succumbed to the disease in February 2018.According to the complaint, the father, who is a doctor, purchased an Optima Restore Floater health insurance policy in February 2017 with a sum insured of Rs 20 lakh. In April 2017, his son was hospitalised at Apollo Hospital, Navi Mumbai, with severe abdominal pain and underwent emergency surgery.When the doctor sought reimbursement, Apollo Munich rejected the claim on May 27, 2017, alleging that he had failed to disclose the child’s earlier speech delay while obtaining the policy. The doctor responded that speech delay was neither a disease nor a medical condition and that his son had naturally overcome it during childhood.Story continues below this adSoon after the claim was rejected, the child was diagnosed with Burkitt’s Lymphoma, an aggressive form of blood cancer. He underwent chemotherapy but later developed a fungal brain infection, requiring multiple brain surgeries at Tata Memorial Hospital and Apollo Hospital.Despite extensive treatment, the child died in February 2018. The doctor told the commission that he had spent Rs 33.58 lakh on his son’s treatment after the insurer cancelled the policy.Rejecting the insurer’s justification, the commission held that developmental speech delay is merely a variation in childhood milestones and cannot be treated as a chronic disease, pre-existing illness or material fact requiring disclosure in a health insurance proposal.It further found that there was no medical or pathological connection between the child’s speech delay and his later diagnosis of Burkitt’s Lymphoma or the fatal fungal brain infection.Story continues below this adThe commission said 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 commission also noted that Apollo Munich failed to file its written version despite repeated opportunities. As a result, the complainant’s evidence, including medical records, bills and policy documents, remained unchallenged.Holding the insurer guilty of deficiency in service and unfair trade practice, the commission observed that its actions reflected “a ruthless, money-making trade practice designed to defeat genuine consumer claims.”Vineet Upadhyay is an Assistant Editor with The Indian Express, where he leads specialized coverage of the Indian judicial system. Expertise Specialized Legal Authority: Vineet has spent the better part of his career analyzing the intricacies of the law. His expertise lies in "demystifying" judgments from the Supreme Court of India, various High Courts, and District Courts. His reporting covers a vast spectrum of legal issues, including: Constitutional & Civil Rights: Reporting on landmark rulings regarding privacy, equality, and state accountability. Criminal Justice & Enforcement: Detailed coverage of high-profile cases involving the Enforcement Directorate (ED), NIA, and POCSO matters. Consumer Rights & Environmental Law: Authoritative pieces on medical negligence compensation, environmental protection (such as the "living person" status of rivers), and labor rights. Over a Decade of Professional Experience: Prior to joining The Indian Express, he served as a Principal Correspondent/Legal Reporter for The Times of India and held significant roles at The New Indian Express. His tenure has seen him report from critical legal hubs, including Delhi and Uttarakhand. ... Read More Tags:blood cancerhealth insurance