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IN THE HIGH COURT OF ALLAHABAD
Shekhar B. Saraf, Vipin Chandra Dixit
Santosh Kumar – Appellant
Versus
Assistant Secretary/Deputy Secretary/Secretary Insurance Ombudsman – Respondent
| Table of Content |
|---|
| 1. writ petition for insurance claim dispute. (Para 1 , 2) |
| 2. petitioner's arguments against claim rejection. (Para 3 , 4) |
| 3. court's analysis of claim rejection grounds. (Para 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21) |
| 4. principles of material fact disclosure in insurance. (Para 22 , 23 , 24 , 25 , 26) |
| 5. court's final order to quash rejection and direct payment. (Para 28 , 29 , 30) |
JUDGMENT :
SHEKHAR B. SARAF, J.
1. This is a writ petition under Article 226 of the Constitution of India wherein the petitioner prays for issuance of a writ of certiorari quashing the impugned order dated May 19, 2023 whereby Assistant Secretary/Deputy Secretary/Secretary, Insurance Ombudsman, Lucknow (hereinafter referred to as ‘respondent no.1’) has dismissed the complaint filed by the petitioner against rejection of life insurance claim by the Senior Divisional Manager, Life Insurance Corporation (LIC) Division Office, Prayagraj (hereinafter referred to as ‘respondent no.3’) concerning policy no.205602934 vide impugned order dated March 23, 2021 which has also been challenged. The petitioner further prays to command the respondents to release the amount
The insurer cannot repudiate a life insurance claim based on non-disclosure of a previous policy if it failed to verify existing records, as this does not constitute material suppression.
Point of Law : There is no good ground to interfere in the orders impugned.
The duty of the proposer to disclose all material facts in the proposal form and the materiality of the non-disclosed information for the assessment of risk in insurance contracts.
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) Proposal form – In filling up the proposal form, the agent normally, ceases to act as agent of the insurer but becomes the agent of the insured and no agent can be assumed to have authority from ....
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....
The duty of utmost good faith in insurance requires full disclosure of all material facts, and non-disclosure can lead to claim rejection.
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....
The duty of the insured to disclose all material facts at the time of obtaining an insurance policy, the significance of material facts in influencing the decision of a prudent insurer, and the conse....
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]
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