Concealment of a non-life-threatening medical condition does not justify the repudiation of an insurance claim if the cause of death is unrelated to the concealed condition.

ORDER :

1. Leave granted.

2. This appeal is directed against the Order dated 16.09.2014 passed by the National Consumer Disputes Redressal Commission, Circuit Bench at Nagpur, Maharashtra (hereinafter referred to as “the National Commission”) in Revision Petition No. 3809 of 2009.

3. The husband of appellant No. 1 herein had taken out a Life Insurance Policy. At the time of taking the policy, he had concealed the fact that he was suffering from lumbar spondilitis with PID with sciatica for which ailment he was taking medical treatment as also he had availed leave on medical grounds.

4. After the policy was given to the husband of appellant No. 1, he suffered myocardial infarction and succumbed to the ailment. When the appellants made a claim in terms of the life insurance policy, they were told that because the deceased had not disclosed his ailment of lumbar spondilitis with PID with sciatica at the time of filling up of the proposal form, therefore, the claim was repudiated.

5. The repudiation of the appellants' claim has been upheld by the National Commission and it is under these circumstances the appellants are before this Court.

6. We have heard learned counsel for the parties.

7. It is not the case of the Insurance Company that the ailment that the deceased was suffering from was a life threatening disease which could or did cause the death of the insured. In fact, the clear case is that the deceased died due to ischaemic heart disease and also because of myocardial infarction. The concealment of lumbar spondilitis with PID with sciatica persuaded the respondent not to grant the insurance claim.

8. We are of the opinion that the National Commission was in error in denying to the appellants the insurance claim and accepting the repudiation of the claim by the respondent. The death of the insured due to ischaemic heart disease and myocardial infarction had nothing to do with his lumbar spondilitis with PID with sciatica. In our considered opinion, since the alleged concealment was not of such a nature as would disentitle the deceased from getting his life insured, the repudiation of the claim was incorrect and not justified.

9. Accordingly, we set aside the order passed by the National Commission and allow the appeal. The respondent will accept the claim made by the appellants within a period of four weeks from today and make the due payment.