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  • Mediclaim cannot be...

Mediclaim cannot be rejected citing existing illness: SC

Medical Dialogues BureauBy Medical Dialogues BureauPublished On 2021-12-29T09:45:00+05:30  |  Updated On 29 Dec 2021 4:15 AM GMT
Mediclaim cannot be rejected citing existing illness: SC

SC 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 overseas.

New Delhi: 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 said. A 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 knowledge.Also Read: Not justified...

New Delhi: 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 said.

A 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 knowledge.

Also Read: Not justified to issue direction to de-reserve vacant doctors' posts: Odisha HC

The proposer is presumed to know all the facts and circumstances concerning the proposed insurance, it added.

While the proposer can only disclose what is known to him, the proposer's 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 said.

"Once 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 judgment.

The 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 States.

Nanda 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 vessels.

Subsequently, the appellant claimed the treatment expenses from the insurer, which was repudiated by the latter stating that the appellant had a history of hyperlipidemia and diabetes, which was not disclosed while buying the insurance policy.

The 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 conditions.

The apex court said the repudiation of the policy by the United India Insurance company was illegal and not in accordance with law.

It 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 overseas.

"If 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.

Also Read: HC reprimands Centre for inadequate report on medical treatment for Bhopal gas tragedy victims

Supreme Court insurance policy mediclaim medical condition health insurance medical insurance medical claim Mediclaim policy hyperlipidemia diabetes ncdrc 
Source : PTI
Medical Dialogues Bureau
Medical Dialogues Bureau

    Medical Dialogues Bureau consists of a team of passionate medical/scientific writers, led by doctors and healthcare researchers.  Our team efforts to bring you updated and timely news about the important happenings of the medical and healthcare sector. Our editorial team can be reached at editorial@medicaldialogues.in.

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