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A. P. SAHI, BINOY KUMAR
Max Life Insurance Company Ltd. – Appellant
Versus
Amarama – Respondent
ORDER
A.P.Sahi, President—The State Commission of Karnataka has allowed CC No.402 of 2018 filed by the respondent/complainant holding that the appellant insurance company was deficient in its services by not reimbursing the claim of the complainant. The deceased husband of the complainant late Mr. Veeresh aged about 49 years had acquired a Max Life Insurance Policy on 10.12.2014. He fell ill in the month of October, 2016 and he died on 26.10.2016 due to aspiration problems as reported. The respondent/complainant, being the nominee and widow of Mr Veeresh, requested for the reimbursement for the risk covered under the said policy, but the same was repudiated vide letter dated 31.03.2017, on the ground that the policy had lapsed due to non- payment of renewal premium by the due date.
2. The complainant protested against the same that the payments had already been made and therefore, the policy had not lapsed with the grace period available and therefore the claim deserved to be reconsidered. The insurance Company took up the matter and vide letter dated 22.05.2017 intimated the complainant that her claim has been admitted for an evaluation.
3. On 27.06.2017 the final repudiation letter
Insurance – Repudiation of death claim – If insured had not been found to be medically deficient as on date of proposal form then question of any allegation about past disease has to be viewed accord....
(1) Full Knowledge – DLA had the full knowledge of pre-existing ailments at the time of filling the proposal form and there was a nexus with preexisting disease and the cause(s) of death.(2) Proposal....
1) Per Sec. 45 of Insurance Act, claim can be repudiated, if it is proved that the assured knowingly and fraudulently suppressed the material facts.2) Contractual duty so imposed on the Insured is su....
(1) Contract of Insurance – A contract of insurance is one of utmost good faith. A proposer who seeks to obtain a policy of life insurance is duty bound to disclose all material facts bearing upon th....
There should be nexus with pre-existing disease & disease for which claim has been made.
(1) Medical condition – There is a good possibility that the DLA was not aware of his medical condition prior to filling the Proposal Form and OP has not established anything to the contrary.(2) Duty....
Point of Law : No fault can be found with the repudiation and the order of Ombudsman affirming the said repudiation and disallowing the claim. [Para 13]
Insurance – Materiality of a certain fact is to be determined on a case-to-case basis – However, burden of proving fact which excludes liability of Insurer to pay compensation lies on Insurer alone a....
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....
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