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B. SUDHEENDRA KUMAR, AJITH KUMAR D., RADHAKRISHNAN K. R.
New India Assurance Co. Ltd. – Appellant
Versus
Sudhakara Shenoi – Respondent
JUDGMENT
Ajith Kumar D., Judicial Member—This is an appeal filed by the opposite party in C.C.No.59/2019 on the files of the District Consumer Disputes Redressal Commission, Alappuzha (the District Commission for short).
2. On 25.10.2021 the District Commission had partly allowed the complaint and directed the 1st opposite party to pay Rs.74,026/- (Rupees Seventy Four Thousand and Twenty Six only) along with 9% interest, to refund Rs.1,846/- (Rupees One Thousand Eight Hundred and Forty Six only) along with interest @9% by the 3rd opposite party, to pay Rs.15,000/- (Rupees Fifteen Thousand only) each by the 1st and 3rd opposite parties and costs Rs.3,000/- (Rupees Three Thousand only). There was also a stipulation in the order against the 3rd opposite party to pay the amount to the complainant and realise the same from the persons responsible.
3. Being aggrieved by the aforesaid order, this appeal has been filed.
4. The complaint was filed by one Sudhakara Shenoi by resorting to Section 12 of the Consumer Protection Act, 1986. The complainant had renewed his health insurance policy coverage in 2018 with the 1st opposite party through the 3rd opposite party, Canara Bank, Mullackal Br
(1) Health Insurance Policy [Mediclaim Policy] – Repudiation based on exclusion clause which was not communicated to insured can never be pressed into service to deprive insured from claiming relief.....
Existence of Disease – There is no reason for the insurance company to connect the existence of diabetes with the disease for which treatment has been taken.
(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 ....
Medical Examination – Insurance company is responsible for conducting a medical examination of the policyholder in advance.
Insurance Policy must be read holistically so as to give effect to reasonable expectations of all parties including insured & beneficiaries.
Life Insurance Policy – Repudiation of death claim on the ground of suppression of material facts – Mere existence of past medical records is insufficient unless knowledge on part of insured is prove....
(1) Insurance – A contract of insurance is one of utmost good faith. (2) Proposer – Proposer who seeks to obtain a policy of life insurance is duty bound to disclose all material facts bearing upon t....
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