Vadodara: The Vadodara District Consumer Disputes Redressal Commission (Additional) has ruled that mere non-disclosure of pre-existing diseases cannot be grounds for rejecting an insurance claim unless it is proven that such ailments materially impacted the insured’s life expectancy.The consumer forum delivered this judgment while hearing the complaint of Haresh Thadani, a resident of Dandia Bazaar in Vadodara. The forum directed HDFC Standard Life to pay Rs 12.37 lakh to the complainant, along with 9% interest from the date of claim repudiation. Additionally, the company was ordered to pay Rs 10,000 for mental agony and Rs 5,000 towards litigation costs within 45 days.According to case details, Haresh’s father, Anup Thadani, had taken a life insurance policy of Rs 13 lakh from HDFC Standard Life Insurance Company Ltd in 2015 while availing a loan. Anup passed away in Dec 2016 due to cardiac arrest. Haresh subsequently filed a claim in January 2017, which the insurance company repudiated in March 2017. The insurer cited non-disclosure of pre-existing conditions such as ischemic heart disease, coronary artery disease, single vessel disease, hypertension, and obesity.Haresh filed a complaint in April 2018 with the consumer forum, alleging that the insurance agent filled out the proposal form without verifying the necessary information or obtaining signatures from the deceased, who was illiterate. He claimed the form was filled by the insurance agent, without proper disclosure or consent.The insurer contended that the deceased had a history of ischemic heart disease and related conditions, and had undergone angiography in 2011. It argued that, had this information been disclosed, the policy would have been rejected at the outset.However, the forum observed that the insurer had repudiated the claim not on the grounds of fraud, but on the grounds of misstatement. It held that sub-section 4 of the amended Section 45 of the Insurance Act applied in this case, which requires that any misstatement or suppression of material facts must have a direct bearing on the risk undertaken by the insurer.The forum noted that the insurer failed to mention in the repudiation letter that the suppressed diseases were material to the insured’s life expectancy. It also did not consider the evidence submitted by the insurer as valid or sufficient to support the claim rejection.“Even if the ailments are assumed to be pre-existing for the sake of argument, the insurer has not proven that they were material to the life expectancy of the insured or had a direct bearing on the risk,” the forum observed while ordering the insurance firm to pay Rs 12.37 lakh to the complainant with 9% interest from the date when they repudiated the claim .
