Insurance Claim Can’t Be Denied On Ground Of Common Lifestyle Diseases
But Insurer Should Not Hide Info, Says NCDRC
The National Consumer Disputes Redressal Commission (NCDRC) had held that insurance claim cannot be denied on the ground of common lifestyle diseases such as diabetes or hypertension but that does not give right to the insured to suppress information in respect of such diseases.
The commission also reiterated that suppression of any information relating to pre-existing disease if it has not resulted in death or has no direct relationship to cause of death, would not completely disentitle the claimant from claiming the insured amount.
NCDRC member Prem Narain said so while deciding the appeal of one Neelam Chopra, a resident of Mohali in Punjab.
Her husband had taken an LIC policy in the year 2003 and after being medically examined by a panel of doctors, he was issued the policy w.e.f. 25.12.2002 to 25.6.2026.
The husband of the complainant died on January 7, 2004 due to cardio-respiratory arrest. Her claim was rejected by LIC on the ground that the insured had suppressed material information regarding his health at the time of effecting the policy as he suffered from diabetes and LL Hansen’s disease.
When Neelam moved the District Forum, LIC was told to pay her the insurance claim amount of Rs 5 lakh along with 12 per cent interest besides Rs 25,000 as compensation for mental agony and Rs 5,000 as cost of litigation. The State Commission of Haryana allowed the appeal moved by LIC. This is when Neelam moved NCDRC. The NCDRC noted, “…the Deceased Life Assured (DLA) died on 07.01.2004 and therefore, the disease on account of which the death occurred was not prevailing on the date of filing of the proposal form as the proposal form was filled on 24.01.2003. It has also been alleged that the DLA was suffering from diabetes as mentioned in the treatment record of PGI Chandigarh. He was suffering for 3-4 years from diabetes. In the certificate of Medical Attendance, it is also mentioned that the DLA was suffering from diabetes, however, diabetes was under control. “So far as the life style diseases like diabetes and high blood pressure are concerned”, the Commission quoted from the Delhi High Court judgment in case titled Hari Om Agarwal Vs. Oriental Insurance Co. Ltd., wherein it was held that, “Insurance- Mediclaim-ReimbursementPresent Petition filed for appropriate directions to respondent to reimburse expenses incurred by him for his medical treatment, in accordance with policy of insurance- Held, there is no dispute that diabetes was a condition at time of submission of proposal, so was hypertension-Petitioner was advised to undergo ECG, which he did- Insurer accepted proposal and issued cover note- It is universally known that hypertension and diabetes can lead to a host of ailments, such as stroke, cardiac disease, renal failure, liver complications depending upon varied factors- That implies that there is probability of such ailments, equally they can arise in non-diabetics or those without hypertension. It would be apparent that giving a textual effect to Clause 4.1 of policy would in most such cases render mediclaim cover meaningless- Policy would be reduced to a contract with no content, in event of happening of contingency”.
The commission, therefore, held that it was clear that “the insurance claim cannot be denied on the ground of these lifestyle diseases that are so common. However, it does not give any right to the person insured to suppress information in respect of such diseases. The person insured may suffer consequences in terms of the reduced claims.” It also relied on Supreme Court’s decision in Sulbha Prakash Motegaonkar and Ors. Vs. Life Insurance Corporation of India to say that, “… suppression of any information relating to pre-existing disease if it has not resulted in death or has no direct relationship to cause of death, would not completely disentitle the claimant for the claim”. The commission, therefore, set aside the order of the state commission and modified the order of the district forum to the extent that LIC was told to pay only the insurance amount of Rs 5 lakh and compensation of Rs 25,000 along with litigation cost of Rs 5,000. Interest at the rate of 8 per cent would be attracted only if the LIC fails to comply with the order within 45 days.
Courtesy: www.livelaw.in
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Cong says LoPs not invited to Putin banquet, takes swipe at Tharoor for accepting invite
New Delhi (PTI): The Congress on Friday said Leaders of Opposition Mallikarjun Kharge and Rahul Gandhi have not been invited to the banquet for Russian President Vladimir Putin, and took a swipe at its own MP Shashi Tharoor for accepting the invite.
Congress general secretary in-charge communications Jairam Ramesh said, "There has been speculation whether the Leader of the Opposition in the Lok Sabha and the Leader of the Opposition in the Rajya Sabha have been invited for tonight's official dinner in honour of President Putin. The two LoPs have not been invited."
Congress' media and publicity department head Pawan Khera accused the government of breaking protocols daily and not believing in democratic principles.
"There is no invite to both the LoPs, Mr (Mallikarjun) Kharge and Mr (Rahul) Gandhi. This comes as a surprise but I don't think we should be surprised. This government is known to be breaching all protocols. What else to say, ask the government," he told PTI Videos on the sidelines of an event.
Asked about party MP Tharoor getting invited to the banquet and accepting the invitation, Khera said, "Ask Mr. Tharoor. All of us who are in the party, if our leaders don't get invited and we get invited, we need to question our own conscience and listen to our conscience. Politics has been played in inviting or not inviting people, which in itself is questionable and those who accept such an invite is also questionable," Khera said.
"We would have listened to our voice of conscience," he added.
Earlier, Tharoor said there was a time when the chairman of the external affairs committee was routinely invited but that practice seems to have stopped from some years.
"It has been resumed ...I have been invited, yes. I will definitely go," the chairman of the Parliamentary Standing Committee on External Affairs said.
On the LoPs reportedly not getting an invite, Tharoor said, "I don't know on what basis invitations were sent. I think the custom that usually used to be followed was for a wide representation. Certainly, I remember in the olden days, they used to invite not only the LoPs, (but) various other cross section of representatives of different parties. It conveys a good impression."
"I dont know the basis (of invitation), this is all done by the government, by the protocol by the Rashtrapati Bhawan, what do I know. All I can say I have honoured to have been invited. Of course I will go," Tharoor told reporters in the Parliament House complex.
Gandhi on Thursday had alleged that the government tells visiting foreign dignitaries not to meet the Leader of the Opposition due to its "insecurity".
His remarks had come hours ahead of Putin's two-day visit to India.
Gandhi had said it is a tradition that visiting foreign dignitaries meet the LoP but Prime Minister Narendra Modi and the Ministry of External Affairs were not following this norm.
"Normally the tradition is that those who come from abroad have a meeting with the LoP. This used to happen during (Atal Bihari) Vajpayee ji's time, Manmohan Singh ji's time, it has been a tradition but what happens these days is that when foreign dignitaries come and when I go abroad, the government suggests to them to not meet the LoP," Gandhi had told reporters in Parliament House complex.
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