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

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)

Article referred: http://blog.scconline.com/post/2015/06/04/repudiation-of-policy-claim-on-the-ground-of-non-disclosure-of-material-facts-declared-improper.aspx