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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Skipper Curran, bowlers lead PBKS to a five-wicket win over RR
Guwahati, May 15: Skipper Sam Curran played the lead act hitting a well-paced fifty and taking two wickets, as Punjab Kings consigned Rajasthan Royals to a five-wicket defeat in their IPL match here on Wednesday.
The target was a mere 145, but Kings made heavy weather of it on a sluggish track here but Curran (63 not out, 41b, 5x4, 3x6) had a calm head and skills to lift them to their fifth win of the season. PBKS made 145/5 in 18.5 overs.
The Englishman received good support from Jitesh Sharma (22, 20b) as the pair added 63 runs in a fluent fifth wicket partnership.
For Royals, it was their fourth defeat on the trot, but they remained second on the table with 16 points with a qualification to the playoffs to boot with.
The Kings’ chase began on a shaky note as they lost Prabhsimran Singh in the first over itself to Trent Boult.
But bigger jolts were in store as an impressive Avesh Khan (2/28) scalped two wickets in the fifth over.
The right-arm pacer first plucked the important wicket of Rilee Rossouw, who played some strong shots in his 13-ball 22, and then jettisoned in-form Shashank Singh for a two-ball naught.
Shashank failed to connect a fuller, straighter one from Avesh while attempting a flick, and the 141 kmph delivery thudded on his bat. Shashank did not even bother to use DRS as he walked away.
Punjab gained some ground through the alliance between Curran and Jitesh, who smoked R Ashwin for two sixes.
Curran too gave a dose of punishment to the veteran offie, lofting him for a wonderful six over extra cover.
But the blossoming stand was snapped by Yuzvendra Chahal (2/31), leaving PBKS at 111 for five in the 16th over.
However, Curran and Ashutosh Sharma (17 not out, 11 balls) knocked off the remaining runs without further drama.
Earlier, despite a well-tuned 48 from local hero Riyan Parag, RR struggled against an array of accurate bowlers on a rather slow pitch, meandering to a sub-par 144 for nine.
R Ashwin (28, 19b, 3x4, 1x6) and Parag (48, 34, 6x4) tried to accelerate during their 50-run stand for the fourth wicket but it could only bring in a temporary momentum for RR.
In fact, lethargy had set in very early in the Rajasthan innings after the early loss of Jaiswal, who chopped a Curran (2/24) delivery back on to his stumps.
Sanju Samson (18), who went past 500-run in a season for the first time in his IPL career, and Tom-Kohler Cadmore (18, 23b) stitched 36 runs for the second wicket but took six overs for it.
But with Curran and Arshdeep finding a hint of swing and maintaining a good line, scoring was not an easy proposition for the RR batters.
Eventually, Samson, who tried a hopping cut off pacer Nathan Ellis, gave a simple catch to Rahul Chahar at point in the seventh over.
Cadmore too returned to the dugout in the next over, as his almighty heave off leg-spinner Chahar (2/26) could not progress beyond Jitesh in the deep.
Those twin dismissals actually paved the way for the best phase in the Royals’ innings as Ashwin and Parag pressed their foot on the right pedal.
Ashwin displayed his batting skills, smashing Chahar for 17 runs in the 12th over that included a sequence of 6, 4, 4 and the first four was a stunning reverse scoop over backward point.
But he could not further extend his innings, lofting Arshdeep to Shashank.
Parag, usually a free-flowing batter, had to curb his flair in front of a hugely adoring home crowd because of the regular fall of wickets at the other end.
But a late cut off Curran that sped to third man stood as a testament of his ability and timing as he also moved past the 500-run mark for the season, before getting trapped in front of the wicket by Harshal Patel.
However, apart from conquering those little peaks the RR batters failed to slip into the top gear consistently.
