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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Delhi: Father, son held for killing 19-year-old woman in suspected honour killing
New Delhi (PTI): The Delhi Police has arrested a man and his son for allegedly murdering his 19-year-old daughter in west Delhi's Hari Nagar area, an official said on Friday.
The case first came to light on April 1 after a PCR call was received around 2 pm, alleging that a woman had been killed by her family members and her body was being taken for last rites, he said.
The accused, identified as Mohammad Maneer (55), a vegetable vendor, and his son Meraj Ali (19), were arrested in connection with the case, the officer said.
The victim had been in a relationship with a man from her native place for the past two years, which was opposed by her father, Maneer and brother Meraj, he said.
"When the girl did not end the relationship despite objections, the family killed her," the officer said.
On April 1, the police said that when their team reached the spot, they found that the woman's body was being taken for burial.
Acting on the input, the burial process was stopped over suspicion of honour killing.
"Police intercepted the family members and took possession of the body," he said.
Police said that the man who had made the PCR told them that the woman was in love with his cousin.
During the inquiry, police also interacted with the PCR caller, who said his cousin, a friend of the deceased, had informed him about the situation and suspected foul play, prompting him to alert the police control room.
The body of the woman was subsequently shifted to the mortuary of Deen Dayal Upadhyay Hospital for preservation and postmortem.
Police said that both the crime team and the forensic science laboratory (FSL) team were called to inspect the scene and collect evidence.
Police said that, as per the postmortem report, the cause of death was identified as smothering, indicating that the woman was suffocated.
A preliminary inquiry also revealed that the family had initiated preparations for the last rites soon after the woman's death, raising suspicion about the circumstances.
Initial investigation pointed to the family's opposition to the woman's relationship.
"The family members of the woman saw her with the man, and she was taken back home. We got to know that she was beaten up and even locked inside the house for some days," a source said.
Further investigation into the matter is underway, police added.
