Insurers must substantiate claims of preexisting conditions to deny coverage; reliance on post-factum certifications is insufficient. Writ jurisdiction applies to private entities performing public duties.

ORDER :

(G.R. SWAMINATHAN, J.)

Heard the learned counsel appearing for the writ petitioner and the learned counsel appearing for respondents 3 to 5.

2. The petitioner's husband had availed loan from the third respondent herein after mortgaging the petition mentioned property. The loan was also duly insured with HDFC Life Insurance Company Ltd.. The loan was sanctioned on 31.07.2021. The insurance policy was taken contemporaneously and the policy was valid from 31.07.2021 up to 30.07.2024. The petitioner's husband passed away on 14.01.2023 due to cardiac arrest. The petitioner informed the insurance company to honour the insurance claim so that the loan liability would be automatically liquidated. The insurance company informed the petitioner vide communication dated 31.03.2023 that since there was suppression of preexisting disease, claim cannot be honoured. Challenging the same, this writ petition came to be filed.

3. The petitioner had arrayed HDFC Life Insurance Co. Ltd., as respondents 1 and 2. Address of the headquarters was shown as the address for the first respondent, while the address of the branch office was shown as the address for the second respondent. Notices were sent through Court as well as privately. Notices were served on the insurer. Though the names of respondents 1 and 2 are printed in the cause list, they have not chosen to enter appearance.

4. The creditor, namely, Bajaj Finserv Finance Ltd., is before this Court. I requested the learned counsel for the creditor to inform the insurer about the listing of this case. Best efforts were taken by the fifth respondent to intimate HDFC Life Insurance Company Ltd. But still there is no response.

5. The insurance claim has been rejected only for the reason that the petitioner's husband was suffering from a preexisting disease, namely, hypertension. In this regard, the sixth respondent has given a medical certificate. A copy of the same has been enclosed at page Nos.31 to 33 of the typed set of papers. The petitioner in the affidavit filed in support of this writ petition has taken a specific stand that since the sixth respondent is a panel doctor for the insurance company, he had given a false certificate. Paragraph Nos.10 and 11 of the affidavit filed in support of the writ petition read as follows:-

“10. I state that having known the certificate issued by the sixth respondent doctor, I enquired with him regarding the certificate issued by him dated 14.01.2023, and he replied that due to inadvertently he indicated as 5 years, and again he issued another certificate dated . 04.2023 indicating that my husband took treatment six months back for Hyper tension, and my husband was on regular treatment for the past six months.

11. It is respectfully submitted that the 6^th respondent doctor is discharging his duties without professional ethics and on collusion with the first respondent insurance company. It is pertinent to state that my husband has not taken any treatment with him for a single day either before his private clinic or before the Government Hospital. On the other hand, I have taken treatment before him in his private clinic for lungs infection.”

Ground H reads as follows:-

“The first respondent ought not to have relied upon the certificate issued by is own doctor indicating contradictory statement, and the petitioner's husband has not taken any treatment before him for a single day.”

6. The petitioner has rightly arrayed the said doctor as the sixth respondent. Notice issued to the sixth respondent has been duly served and his name has also been printed in the cause list. He has also not chosen to enter appearance. In these circumstances,