Skip to main content

Insurer faulted for failure to detect disease

The state consumer commission has directed LIC to pay around Rs 44,000 in compensation plus the insured amount to a widow whose claim it rejected on the grounds that her husband had suppressed the fact that he was suffering from HIV while applying for the insurance. The commission said the medical check-up done when the man applied for insurance should have detected he had HIV as well as tuberculosis.

LIC has to pay the woman a total of Rs 1.34 lakh.

Reprimanding the insurance company, the Maharashtra State Consumer Disputes Redressal Commission said that it was extremely difficult to believe that the mandatory medical examination and the doctor's examination of the insured person failed to assess and detect a prolonged ailment and symptoms of tuberculosis and HIV. The commission said that the insured person also may not have been aware of the infections and changes taking place in his body. "He, therefore, cannot be attributed to have suppressed material information consciously and intentionally while filling the proposal form of the insurance company."

The husband of the complainant had taken Jivan Mitra (Triple Cover Endowment) from the insurance company and it was effective from March 10, 2004. On July 25, 2005, the man died of acute chronic renal failure. His widow then filed the claim. On May 20, 2006 the insurance company rejected the claim while alleging that while filling the proposal form the deceased had hidden the fact that he was suffering from HIV and TB. The company said the diseases were recorded in the history submitted by the deceased when he was getting admitted to hospital.

Aggrieved, the woman filed a complaint in a district forum. On July 18, 2007, the forum dismissed the complaint, following which she filed an appeal in the state commission. The woman submitted that the deceased was unaware of the ailments cited and died of a totally different reason. She said there was no correlation between the illness history and cause of death.

The insurance company alleged that the discharge papers of the Pune hospital showed that the deceased was suffering from HIV and TB for two years prior to giving the history.

The commission observed that the discharge card was not tendered in evidence. "There is no evidence as to who had received the said history and as to who had given it. Under the circumstances, its authenticity as well as correctness can be doubted. Hence, the very basis of the insurance company's repudiation gets blown off," the commission said.

Refuting the insurance company's defence, the commission said, "We find that the insurance company failed to show that the deceased suppressed material information while filling a proposal form. Thus, the repudiation of insurance claim being arbitrary, the deficiency in service on part of the insurance company is well established."

Article referred: http://timesofindia.indiatimes.com/city/mumbai/Insurer-faulted-for-failure-to-detect-disease/articleshow/19589364.cms

Comments

Post a Comment

Most viewed this month

One Sided Clauses In Builder-Buyer Agreements Is An Unfair Trade Practice

In CIVIL APPEAL NO. 12238 OF 2018, Pioneer Urban Land & Infrastructure Ltd. vs Govindan Raghavan, an appeal was filed before the Supreme Court  by the builder against the order of the National Consumer Forum. The builder had relied upon various clauses of the Apartment Buyer’s Agreement to refute the claim of the respondent but was rejected by the commission which found the said clauses as wholly one-sided, unfair and unreasonable, and could not be relied upon. The Supreme Court on perusal of the Apartment Buyer’s Agreement found stark incongruities between the remedies available to both the parties. For example, Clause 6.4 (ii) of the Agreement entitles the Appellant – Builder to charge Interest @18% p.a. on account of any delay in payment of installments from the Respondent – Flat Purchaser. Clause 6.4 (iii) of the Agreement entitles the Appellant – Builder to cancel the allotment and terminate the Agreement, if any installment remains in arrears for more than 30 da...
Post a Comment
Read more

Inherited property of childless hindu woman devolve onto heirs of her parents

In Tarabai Dagdu Nitanware vs Narayan Keru Nitanware, quashing an order passed by a joint civil judge junior division, Pune, the Bombay High Court has held that under Section 15 of the Hindu Succession Act, any property inherited by a female Hindu from her father or mother, will devolve upon the heirs of her father/mother, if she dies without any children of her own, and not upon her husband. Justice Shalini Phansalkar Joshi was hearing a writ petition filed by relatives of one Sundarabai, who died issueless more than 45 years ago on June 18, 1962. Article referred:http://www.livelaw.in/property-inherited-female-hindu-parents-shall-devolve-upon-heirs-father-not-husband-dies-childless-bombay-hc-read-judgment/
Post a Comment
Read more

Court approached in the early stages of arbitration will prevail in all other subsequent proceedings

In National Highway Authority of India v. Hindustan Steelworks Construction Limited, the Hon'ble Delhi High Court opined that once the parties have approached a certain court for relief under Act at earlier stages of disputes then it is same court that, parties must return to for all other subsequent proceedings. Language of Section 42 of Act is categorical and brooks no exception. In fact, the language used has the effect of jurisdiction of all courts since it states that once an application has been made in Part I of the Act then ―that Court alone shall have jurisdiction over arbitral proceedings and all subsequent applications arising out of that agreement and arbitral proceedings shall be made in that Court and in no other Court. Court holds that NHAI in present case cannot take advantage of Section 14 of the Limitation Act, 1963 for explaining inordinate delay in filing present petition under Section 34 of this Act in this Court.
Post a Comment
Read more