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In a matter before SC where an individual named Manish Gupta while obtaining a Medi-claim policy from LIC failed to disclose all health details and medical information. He in the query from answered negative to a question asking about any “cardiovascular disease such as Palpitations, Hearth Attack, Stroke, and chest pain.”
In due course when the applicant went through a Mitral Valve Replacement surgery and claimed for the amount. His claim was repudiated by LIC on the ground that he was suffering from preexisting illness. The note of the doctor stated that “Rheumatic Heart disease since Childhood”.
The patient however appeared in person submitted that while the information which has been recorded by doctor was is based on disclosure made by him but he just informed about “fever and joint pains since childhood” and the discovery of Rheumatic Heart disease was made during course of treatment.
The district and National Forum had earlier decided in favor of patient but the SC overturning those judgments held that the documentary material indicates that there was a clear failure on the part of the respondent to disclose that he had suffered from rheumatic heart disease since childhood. Such failure is a valid ground for repudiation in accordance to rems of the exculsions contained in the policy. “The failure of the insured to disclose the past history of cardiovascular disease was a valid ground for repudiation”.
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