Repudiation of claim of Rs. 5 crores on the ground of concealment of material facts – Earlier insurance history information was concealed and date of birth (14.10.1960) given in the form did not tally with the birth certificate of 1961 is Illegal.
Judgment dated 11.10.2023 of the National Consumer Disputes Redressal Commission in the case of Consumer Case No.1289 of 2015 – Dipti Yogesh Parekh Vs. Birla Sun Life Insurance Co. Ltd.
On 31.12.2012, late husband of the complainant had taken Protector Plus Plan of the respondent for Rs.5 crores for a term of 20 years after medical examination as per the details given in para 3 of the judgment.
On the night of 25.4.2014, the insured developed chest pain while in Rajkot, he was admitted in the hospital and he died on 26.4.2014.
On 18.6.2014, the complainant lodged the claim with the respondent.
On 20.2.2015, the claim was rejected on concealment of material facts on the ground that –
Reply to the queries relating to his health and previous insurance given in the negative were incorrect. On 3.1.2004, the deceased had applied for insurance from the respondent and it was rejected on adverse health history. Secondly, date of birth in 1960 in the proposal form did not tally with 1961 birth certificate of Sangli Corporation.
HELD that both the grounds are illegal. Information relating to insurance history as per question no.12 cannot be said to be “material” for underwriting the risk cover by the Insurer. The present policy was issued after in-depth medical examination.
Higher premium was charged on the basis of 15.10.1960 date of birth and no prejudice was caused to the insurer. It could not be considered as deliberate concealment of any material fact since no prejudice was caused to the insurer.
