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SANDEEP MEHTA, VIKRAM NATH
Life Insurance Corporation – Appellant
Versus
Sunita – Respondent
| Table of Content |
|---|
| 1. claim based on life insurance policy details and hospitalization. (Para 2 , 3 , 4 , 5) |
| 2. dispute regarding the repudiation of claim after the lower forums' decision. (Para 6 , 7 , 8) |
| 3. controversy over evidence of chronic alcoholism. (Para 11 , 12) |
| 4. analysis of policy terms and conditions concerning the claimants. (Para 13 , 14 , 15) |
| 5. distinction of case law regarding non-disclosure and its impact on claims. (Para 16 , 17 , 18) |
| 6. final ruling on the appeal and compensation aspects. (Para 19 , 20 , 21 , 22) |
ORDER :
1. Leave granted.
2. The present appeal arises from the order dated 12.03.2020 passed by the National Consumer Disputes Redressal Commission (hereinafter, "NCDRC") in Revision Petition No. 54 of 2018. By this order, the NCDRC upheld the decision of the State Consumer Disputes Redressal Commission ("SCDRC") and the District Consumer Disputes Redressal Forum ("District Forum"), directing the appellant, Life Insurance Corporation ("LIC"), to compensate the respondent-claimants in accordance with the terms of the life insurance policy.
3. The deceased insured, Sh. Mahipal, husband of Respondent No.1, was a policyholder under the LIC's "Jeevan Arogya" scheme,
(1) Proposal form – In filling up the proposal form, the agent normally, ceases to act as agent of the insurer but becomes the agent of the insured and no agent can be assumed to have authority from ....
There should be nexus with pre-existing disease & disease for which claim has been made.
(1) The “Three-Year Rule” (Section 45) – Under the amended Section 45, a policy cannot be questioned after three years from issuance or risk commencement on any ground.(2) Agent’s Responsibility – Th....
(1) Proof of delivery - In the absence of proof of delivery, therefore, Commission cannot rely solely on the Respondent’s statement before the District Commission that it had duly supplied the terms ....
Revival of Policy - It is settled proposition of law that when the policy has been revived, it revives from the date when it was originally issued.
Insurers cannot repudiate a claim without establishing a direct causal link between disclosed ailments and the cause of death.
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