Back
IN THE HIGH COURT OF KERALA AT ERNAKULAM
BASANT BALAJI
Kumud Mahendra Parekh – Appellant
Versus
National Insurance Company Ltd – Respondent
JUDGMENT :
THE HONOURABLE MR.JUSTICE BASANT BALAJI
The petitioner had availed a medical insurance policy to get insured in connection with an overseas journey to the United Kingdom and Dubai. The insurance policy was valid from 25.09.2019 to midnight of 10.11.2019. Ext.P1 is the policy issued, and as per the contract of the policy, an amount of 2,50,000 USD was covered towards accident (medical expenses), 25,000 USD towards personal accident, 1,000 USD towards loss of checked-in baggage, 100 USD for delay of checked-in Baggage, 250 USD towards loss of passport, 2,00,000 USD towards personal liability and 10,000 USD towards illness (medical expenses).
2. The petitioner was subjected to a medical examination, and a detailed investigation was conducted by a competent Doctor and Ext.P2 Medical Examination Report was produced before taking the policy. It is specifically noted that, there was no previous history of any operation or existing disability. When the petitioner was abroad, she fell ill due to fever and suffered difficulty to breath. An amount of Rs.1,77,894.57 (9007.32 AED) was spent for the treatment, and after returning, the petitioner has lodged a detailed representation and r
The court held that a claim cannot be denied based on a pre-existing condition unless there is evidence of treatment or symptoms within 48 months prior to the policy issuance.
Disclosure of pre-existing conditions is crucial for insurance claims; failure to disclose can lead to claim denial if conditions were treated or diagnosed within 48 months prior to policy inception.
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]
The court emphasized the duty of disclosure in insurance contracts, ruling that claims cannot be repudiated without sufficient medical evidence supporting pre-existing conditions.
Proof - The Appellants further asserted that the Respondent also had history of asthma but no evidence has been placed by them to substantiate the same.
Insurers cannot reject claims on trivial grounds or without substantial evidence of pre-existing conditions, as it violates the insured's fundamental rights and undermines the principles of good fait....
An indispensable Tool for Legal Professionals, Endorsed by Various High Court and Judicial Officers
Please visit our Training & Support
Center or Contact Us for assistance
Scan Me!
India’s Legal research and Law Firm App, Download now!
For Daily Legal Updates, Join us on :
Back to top
