‘Inappropriate to claim man intentionally hid disease': Insurance firm ordered to pay
Raipur: The Chhattisgarh State Consumer Disputes Redressal Commission directed an insurance firm backed by a nationalised bank to pay Rs 50 lakh to Savitri Salam, whose husband's insurance claim was initially rejected.
The commission found that the insurer failed to conclusively prove concealment of pre-existing diseases by the deceased.
Savitri Salam, a resident of Surdongar village in Keshkal tehsil, filed a complaint after her husband's health deteriorated, leading to his demise on 16 June 2021. She sought a claim under a policy taken by her husband, but the insurance firm rejected it, alleging that he provided incorrect information about his pre-existing medical conditions and treatment in the proposal form.
The insurance company argued before the district consumer commission that the insured suffered from diabetes and heart disease prior to taking the policy, and this was noted in his medical records from AIIMS, Raipur, as part of his medical history. Based on this, the claim was rejected due to misrepresentation of health information in the proposal form.
The District Consumer Commission, Kanker, accepted Savitri Salam's complaint and directed the insurance company to pay the full claim amount within one month.
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The insurance company then challenged this order before the Chhattisgarh State Consumer Disputes Redressal Commission.
During the appeal hearing, the bench of Justice Gautam Chourdiya, president, and Pramod Kumar Varma, member, determined that the claim was rejected solely based on a note in the AIIMS, Raipur, medical record. No other medical records were presented to conclusively prove that the insured suffered from diabetes and heart disease before applying for the policy, underwent any prior treatment, or was on continuous medication.
The commission observed there was no evidence to suggest that the insured was aware of these conditions when he submitted the proposal.
The state commission concluded that it was not appropriate to claim the insured intentionally concealed important facts about his pre-existing diseases in the proposal. The appeal was rejected, and the insurance company has been directed to pay Rs 50 lakh from the life insurance claim, after deducting the Rs 56,621 premium amount already refunded to Savitri Salam by the insurance company. This amount will also include 7% annual simple interest from the date the complaint was filed (27 Dec 2023).
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