Supreme Court says insurers cannot deny claims by citing existing health conditions
New Delhi:
The Supreme Court said that an insurance company cannot deny (reject) a claim by citing an existing health condition disclosed by the insured in the proposal form.
A panel of judges DY Chandrachud and BV Nagarathna also said a petitioner is obligated to disclose to the insurance company all material facts of which he is aware.
The proponent is supposed to know all the facts and circumstances related to the proposed insurance, it added.
Although the proponent may disclose only what is known to him, the proponent’s obligation to disclose is not limited to his actual knowledge, it extends to facts important which in the ordinary course of business he must know, the court said.
Once an insurance policy has been issued after assessing the health condition of the insured, the insurance company cannot deny a claim by citing the existing medical condition, which is approved by the insured. insured disclosed in the application and what condition led to a particular peril in which the insured claims a claim,” the bench said in a recent judgment.
The Supreme Court heard Manmohan Nanda’s appeal against the order of the National Consumer Dispute Settlement Commission (NCDRC), dismissing his appeal to claim compensation for development medical expenses. born in the United States.
Mr. Nanda purchased a Business and Vacation Abroad Contract as he intended to travel to the United States. Upon arrival at the San Francisco airport, he suffered a heart attack and was admitted to the hospital, where an angioplasty was performed on him and three stents were inserted to remove the blockage from his heart vessels.
The appellant then asked the insurance company to cover the cost of the treatment, which was denied by the appellant stating that the appellant had a history of hyperlipidemia and diabetes, which was not disclosed. disclosed when purchasing an insurance policy.
The NCDRC concluded that because the complainant was taking a statin drug, which was not disclosed during the purchase of the health policy, he had failed to comply with his obligation of full disclosure of his medical condition.
The Supreme Court said that United India Insurance’s denial of the policy was illegal and inconsistent with the law.
It says the goal of purchasing a medical indemnity policy is to seek compensation for a sudden illness or illness that is not expected or is imminent and may occur abroad.
“If the Insured suffers a sudden illness or illness which is not expressly excluded under the policy of insurance, the insurer is obligated to indemnify the appellant for subsequent expenses incurred, ” said the bench.
(Except for the title, this story has not been edited by NDTV staff and is published from an aggregated feed.)
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