Travel Insurance – Treatment of Haematuria in USA – Repudiation for non-disclosure of pre-existing disease
The petitioner had taken Travel Super Age Alite Insurance Policy for his USA trip for 24.6.2014 to 21.09.2014 extended to 27.10.2014 for USD 50,000. The petitioner indicated “NO” about pre-existing illness or treatment or disease. However, the petitioner had disclosed that he had hypertension and asthma.
On 25.9.2014, while in USA the petitioner was diagnosed with Haematuria. The hospital sent medical bill of USD 11,516 directly to the respondents for payment.
On 27.2.2015, the claim was repudiated stating that “prostatic hypertrophy” pre-existing disease was not disclosed in the proposal.
HELD (i) the Insurer did not establish pre-existence of disease through any medical examination or proved, (ii) the conclusion of the Insurer that the petitioner had symptoms for 5-7 days which was not disclosed cannot be considered as withholding of material evidence and (iii) it cannot be expected that an average person would diagnose himself based on symptoms and disclose illness.
Even otherwise, “prostatic hypertrophy” is an age related prostrate gland enlargement which can cause difficulty in urination. This ailment was not detected by the examining doctor at the stage of policy proposal on 21.6.2014 and therefore, non-disclosure of the same on 23.9.2014 by the petitioner cannot be considered as wilful suppression of material facts.
Order dated 30.9.2024 of NCDRC in Revision Petition No.277 of 2017 of Kashmir Singh Gill V. Bajaj Allianz General Insurance Company Ltd
