Madras HC orders disbursal of Insurance Claim, says Suppression of Medical Leave and Treatment Not Grounds for Denial
Madras High Court
Chennai: The Madras High Court has directed an insurance company to pay the Rs 10 lakh policy amount to a petitioner who lost her husband. The court stated that the suppression of certain facts, such as the deceased’s medical leave history, should not serve as grounds for denying an entire insurance claim.
A bench led by G.k.Ilanthiraiyan was hearing a petition challenging the repudiation of the petitioner's insurance claim. The petitioner's husband, who was the Principal in charge at Government Arts and Science College, Manimedu, Mayiladuthurai District, had subscribed to the policy, which assured a sum of Rs 10 lakhs. The petitioner, the wife of the insured is a nominee.
The insured individual passed away on January 9, 2020, due to sudden cardiac arrest. He had chest pain and immediately, he was taken to hospital, unfortunately, he died without taking any treatment.
After his demise, the petitioner made a claim under the policy, it was denied on the grounds of suppression of material facts that the petitioner was taking treatment for chest pain from the year 2016 onwards and he was admitted to the hospital on several occasions. He also obtained medical leave on many occasions. The claim of the petitioner was rejected and repudiated the amount, which was subscribed to the policy to the tune of Rs. 53,713.
The court stated, “The petitioner suffered from fever and Typhoid, those are incidental to any one life, there is no evidence to show that the petitioner had chronic heart ailments. In fact, on 09.01.2020 he suffered sudden cardiac arrest and died, even before taking any treatment. Therefore, mere suppression of facts that the petitioner had taking treatment during the last 5 years and he obtained medical leave on the health ground are not the reason for rejection of claim.”
The court also pointed out that normally, the application for the insurance policy is filled up by the Agent without getting any instructions from the insured. Moreover, the petitioner did not approach the respondent directly to take the insurance policy. “He was canvased by the agent and the proposal form was also filled up by him without even consulting the insured and obtained the signature. Therefore, it cannot be said that the insured suppressed the fact that he went on medical leave and also admitted in the hospital,” the court added.
To view the order, click the link below:
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