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IN THE HIGH COURT OF KERALA AT ERNAKULAM
P.M.MANOJ
A.M. Muraleedharan – Appellant
Versus
Senior Divisional Manager, Life Insurance Corporation Of India, (LIC Of India) – Respondent
| Table of Content |
|---|
| 1. claim processing and grounds for denial. (Para 1 , 2 , 3 , 4 , 5 , 6) |
| 2. policy conditions and exclusions related to claims. (Para 7 , 8 , 9 , 10 , 11 , 12) |
| 3. writ petition maintainability and jurisdiction considerations. (Para 13 , 14 , 15 , 16) |
| 4. fundamental rights related to medical treatment. (Para 17 , 18 , 19 , 20 , 21 , 22) |
| 5. legal standards for repudiation of insurance claims. (Para 23 , 24 , 25 , 26 , 27 , 28) |
| 6. ambiguity in insurance contracts and contra proferentem. (Para 29 , 30 , 31 , 32 , 33 , 34) |
| 7. insurer’s obligations and transparency in policy terms. (Para 35 , 36 , 37 , 38 , 39 , 40) |
| 8. judicial intervention in insurance claims for public interest. (Para 41 , 42 , 43 , 44) |
JUDGMENT :
P.M. MANOJ, J.
The above captioned writ petitions are preferred against the denial of the full claim and the complete rejection of the subsequent claim by the respondent insurance company, and seeking a direction to quash Exts.P8, P14 and P15.
2. It is the case of the petitioner that he is the policyholder under a policy (LIC’s health plus plan table 901) valid up to 31.03.2024, which commenced on 31.03.2008. It covers medical treatment for the petitioner along with thre
Insurance claims cannot be denied arbitrarily on the basis of unrelated pre-existing conditions, as such actions violate the fundamental rights to medical treatment and fairness under Article 21 of t....
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....
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.
Insurers have the right to repudiate life insurance policies for suppression of material facts, emphasizing the duty of utmost good faith in insurance contracts.
There should be nexus with pre-existing disease & disease for which claim has been made.
The main legal point established in the judgment is that the suppression of material information regarding health condition can only lead to the repudiation of an insurance claim if the cause of deat....
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