SANGITA DHINGRA SEHGAL, PINKI, J. P. AGRAWAL
Birla Sun Life Insurance Company Ltd. – Appellant
Versus
Harish Grover – Respondent
Based on the provided legal document, the key points are as follows:
The case involves a dispute over the validity of life insurance policies issued to the Respondent, with the Appellants claiming that the policies should be declared null and void due to non-disclosure of pre-existing diseases, specifically diabetes mellitus and a history of asthma (!) (!) .
The District Consumer Disputes Redressal Forum found that the Respondent was examined at the time of policy issuance and was declared healthy, with medical reports indicating normal blood sugar levels and no evidence of diabetes or other illnesses at that time (!) (!) .
The Forum emphasized that common lifestyle diseases such as diabetes and hypertension are not to be considered pre-existing diseases unless there is evidence of hospitalization or treatment in the recent past or near the policy issuance date. Merely having a history of such conditions without recent treatment or hospitalization does not constitute concealment (!) (!) (!) (!) (!) .
The insurance company has an obligation to conduct medical examinations before issuing policies to identify pre-existing conditions. In this case, the Respondent was examined and declared healthy, and no medical evidence was produced by the Appellants to substantiate the concealment of any disease (!) (!) .
The legal principles clarify that unless an insured person is hospitalized or operated upon for a disease in the near proximity of policy issuance, such a disease cannot be deemed pre-existing. The concealment of hospitalization or treatment for a disease in this period is the key factor for repudiation of a claim (!) (!) (!) .
The Appellants failed to prove that the Respondent was suffering from diabetes or asthma at the time of obtaining the policies. The blood sugar levels at the time of examination were within normal limits, and no evidence of recent hospitalization or treatment was provided to establish concealment (!) (!) (!) .
The legal position holds that lifestyle diseases like diabetes and hypertension, which are common and controllable, are not to be treated as pre-existing diseases unless there is evidence of recent hospitalization or treatment for such conditions (!) (!) (!) (!) .
The conclusion of the appellate authority is that the Appellants were deficient in providing services by declaring the policies null and void on the grounds of non-disclosure, which was not supported by sufficient evidence. The original judgment of the District Forum was upheld, and the appeal was dismissed (!) .
The Respondent is entitled to the benefits of the policies, and the Appellants are directed to restore the policies along with full benefits, including compensation for mental pain and harassment, as well as costs of litigation (!) .
The overall legal stance underscores the importance of good faith, proper medical examination, and the limited scope of non-disclosure as a ground for repudiation, especially when the insured was not suffering from the disease at the time of policy issuance and there is no recent hospitalization or treatment evidence.
JUDGMENT
Sangita Dhingra Sehgal (President)—The facts of the case as per the District Commission record are:—
“This complaint has been filed with the allegation that the complainant has availed two policies in his name vide Policy No.003671118 and a premium of Rs.1,20,000/- was to be paid annually. The policy was valid from 28.12.2009 and the total sum assured was Rs.25,00,000/-. Second policy No.003867803 on the premium of Rs.1,20,166/- which was valid from 12.3.2010 and sum insured was Rs.6,00,000/- His health check-up was conducted on 16.12.2009 and medical examination report was also submitted. The complainant has paid so far Rs.3,60,000/- in respect of the premium of both policies. A new insurance policy in the year 2011 vide application no. A-42365683 dated 27.7.2011 was applied for and he was put to medical examination on 9.9.2011. The respondent intimated the complainant that they have cancelled the previous policies with immediate effect. The ground taken was non-disclosure of material facts regarding the diabetes mellitus. It amount to breach of trust. The respondent issued a cheque dated 23.9.2012 for an amount of Rs.1,41,907.75/- bearing no.191099 towards the policy n
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