Tue. Sep 22nd, 2020

Repudiation of policy claim on the ground of non-disclosure of material facts, declared improper

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National Consumer Disputes Redressal Commission
(NCDRC): While declaring the repudiation of claim
of a policyholder by the insurance company on the ground of non-disclosure of
material facts as improper, NCDRC directed the insurance company to pay the
insurance cover amount to the policyholder. A pilot of a private airline had
approached NCDRC alleging that he was denied insurance claim on the ground that
he did not disclose the fact that he was a known case of Hypertension and
chronic kidney disease. Earlier, the complainant who was working for Jet Lite
(India) Ltd. as pilot from 01.12.2007 had obtained a policy Ltd. of Rs.1.00
crore in April, 2009 from New India Assurance Co. and paid a sum of Rs.56,
200/- as premium. Later, in December, 2009, when the complainant was declared
‘permanently unfit’  for flying, he
approached the insurance company for his policy claim but his claim was
repudiated on the ground that he did not disclose the fact that he was a known
case of Hypertension and chronic kidney disease. The complainant had alleged
that as the last two medical tests conducted by the Air Force, reveal that the
complainant had met the prescribed medical standards and the insurance policy
was issued after going through the said medical reports, insurance company is
liable to pay the claim amount. After perusing the documents, Commission
observed that, “At the time of renewal of the licence, the complainant had undergone
assessment through Medical Board constituted by Air Force Central Medical
Establishment and it was certified that the complainant met the specified
medical standards.  The said disease was
detected only in June, 2009.  There is
not even an iota of evidence which may go to show that the complainant suffered
from this ailment, prior to April, 2009.” Accordingly, the Commission directed
the insurance company to pay a sum of Rs.50, 00,000/- in favour of the
complainant, with interest @ 9% p.a., from the date of filing of complaint till
its realisation.” The sum of Rs.27, 575/-, which was not earlier refunded by
the company to the complainant was also directed to be refunded with interest @
18% p.a., till its realization. (Capt. A.K.Singh v. New India Assurance Co.
Ltd., 2015 SCC OnLine NCDRC 12, decided on 11.05.2015)
Source: Legal news India

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