Insurer cant repudiate claim by citing existing medical condition SC
New Delhi Dec 28 PTI An insurer cannot repudiate a claim by citing an existing medical condition that was disclosed by the insured in the proposal form once the policy has been issued the Supreme Court has saidA bench of justices D Y Chandrachud and B V Nagarathna also said a proposer is under a duty to disclose to the insurer all material facts within his knowledgeThe proposer is presumed to know all the facts and circumstances concerning the proposed insurance it addedWhile the proposer can only disclose what is known to him the proposers duty of disclosure is not confined to his actual knowledge it also extends to those material facts which in the ordinary course of business he ought to know the court saidOnce the policy has been issued after assessing the medical condition of the insured the insurer cannot repudiate the claim by citing an existing medical condition which was disclosed by the insured in the proposal form and which condition has led to a particular risk in respect of which the claim has been made by the insured the bench said in a recent judgmentThe top court was hearing an appeal filed by Manmohan Nanda against an order of the National Consumer Disputes Redressal Commission NCDRC rejecting his plea seeking a claim for medical expenses incurred in the United StatesNanda had bought an Overseas Mediclaim Business and Holiday Policy as he intended to travel to the US On reaching the San Francisco airport he suffered a heart attack and was admitted to a hospital where angioplasty was performed on him and three stents were inserted to remove the blockage from the heart vesselsSubsequently the appellant claimed the treatment expenses from the insurer which was repudiated by the latter stating that the appellant had a history of hyperlipidaemia and diabetes which was not disclosed while buying the insurance policyThe NCDRC had concluded that since the complainant had been under statin medication which was not disclosed while buying the mediclaim policy he failed to comply with his duty to make a complete disclosure of his health conditionsThe apex court said the repudiation of the policy by the United India Insurance company was illegal and not in accordance with lawIt said the object of buying a mediclaim policy is to seek indemnification in respect of a sudden illness or sickness that is not expected or imminent and that may occur overseasIf the insured suffers a sudden sickness or ailment which is not expressly excluded under the policy a duty is cast on the insurer to indemnify the appellant for the expenses incurred thereunder the bench said PTI PKS RC
New Delhi Dec 28 PTI An insurer cannot repudiate a claim by citing an existing medical condition that was disclosed by the insured in the proposal form once the policy has been issued the Supreme Court has saidA bench of justices D Y Chandrachud and B V Nagarathna also said a proposer is under a duty to disclose to the insurer all material facts within his knowledgeThe proposer is presumed to know all the facts and circumstances concerning the proposed insurance it addedWhile the proposer can only disclose what is known to him the proposers duty of disclosure is not confined to his actual knowledge it also extends to those material facts which in the ordinary course of business he ought to know the court saidOnce the policy has been issued after assessing the medical condition of the insured the insurer cannot repudiate the claim by citing an existing medical condition which was disclosed by the insured in the proposal form and which condition has led to a particular risk in respect of which the claim has been made by the insured the bench said in a recent judgmentThe top court was hearing an appeal filed by Manmohan Nanda against an order of the National Consumer Disputes Redressal Commission NCDRC rejecting his plea seeking a claim for medical expenses incurred in the United StatesNanda had bought an Overseas Mediclaim Business and Holiday Policy as he intended to travel to the US On reaching the San Francisco airport he suffered a heart attack and was admitted to a hospital where angioplasty was performed on him and three stents were inserted to remove the blockage from the heart vesselsSubsequently the appellant claimed the treatment expenses from the insurer which was repudiated by the latter stating that the appellant had a history of hyperlipidaemia and diabetes which was not disclosed while buying the insurance policyThe NCDRC had concluded that since the complainant had been under statin medication which was not disclosed while buying the mediclaim policy he failed to comply with his duty to make a complete disclosure of his health conditionsThe apex court said the repudiation of the policy by the United India Insurance company was illegal and not in accordance with lawIt said the object of buying a mediclaim policy is to seek indemnification in respect of a sudden illness or sickness that is not expected or imminent and that may occur overseasIf the insured suffers a sudden sickness or ailment which is not expressly excluded under the policy a duty is cast on the insurer to indemnify the appellant for the expenses incurred thereunder the bench said PTI PKS RC
