Repudiation of Claim -Treatment of cancer – Suppression of material facts and daily alcohol drinking
The petitioner had taken Health Insurance Policy from M/s. Royal Sundaram General Insurance Co. for Rs.3,00,000/- in 2003 and renewed till 2020.
The said policy was ported to the respondent no.2 with enhanced cover from 2021 to 2024.
The claims for chemotherapy were denied on the ground of non-disclosure of daily drinking alcohol at the time of policy inception and material facts.
The respondent no.2 Ombudsman dismissed the complaint of the petitioner.
HELD that although the claim was rejected on the ground of past existing history but the insurance policy was not repudiated. After replies of the petitioner, the respondent no.2 did not cancel the policy but the policy was continued and renewed. The non-disclosure of previous ailment of hypertension or occasional consumption of alcohol by the petitioner did not materially affect the insurance contract.
After rejection of the claim, the Insurer not only continued the insurance policy but sought to renew the same by seeking another set of hefty premium from the petitioner. The conduct of the Insurer indicates that its mind would never have been affected by disclosure of occasional consumption of alcohol or pre-existing ailment of hypertension. It was ready to renew the insurance policy despite knowledge of both the facts and even though third additional factor of disease of cancer was added to it, it offered to renew the insurance policy at the advanced age of 82 years at reduced premium of Rs.9,10,467/-. Therefore, the rejection of claim by the Insurer is clearly baseless.
Judgment dated 9.5.2025 of the High Court of Bombay in Writ Petition No.18745 of 2024 of Prakash Mehta Vs. The Insurance Ombudsman for State of Goa and Mumbai Metropolitan Region and another
