Back
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. petitioner challenged denial of insurance claims. (Para 1 , 2 , 3 , 4 , 5 , 6 , 7) |
| 2. respondent argues policy conditions support claim denial. (Para 8 , 9 , 10 , 11 , 12 , 13) |
| 3. writ petition maintainability discussed. (Para 14 , 16 , 17 , 18 , 19 , 20 , 21 , 22) |
| 4. repudiation of claims without material suppression is unjustified. (Para 23 , 24 , 26 , 27 , 29) |
| 5. insurance contracts require fair interpretation. (Para 28 , 30 , 31 , 32 , 33 , 34 , 35 , 36) |
| 6. insurers must clarify ambiguous policy terms. (Para 37 , 38 , 39 , 40 , 41 , 42) |
| 7. court quashes previous orders; claim to be reconsidered. (Para 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 three other family members, namely his wife and two children, as evident from Ext.P1 ins
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....
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....
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 materiality of a fact is determined by the circumstances of each case and is a question of fact. A fact to be material has to have a direct bearing on the cause of death, and mere proximity to th....
Insurers have the right to repudiate life insurance policies for suppression of material facts, emphasizing the duty of utmost good faith in insurance contracts.
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....
There should be nexus with pre-existing disease & disease for which claim has been made.
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
