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No Evidence Of Death Due To Pre-Existing Disease, Haryana State Commission Holds Max New York Life Insurance Liable For Deficiency In Services
Smita Singh
12 Jun 2024 11:00 AM IST
The State Consumer Disputes Redressal Commission, Haryana bench of S.C. Kaushik (Member) held Max New York Life Insurance Co. Ltd liable for deficiency in services for dismissing a genuine claim based on non-disclosure of a pre-existing renal disease. The bench held that the Insurance Company failed to prove that the reason of death was due to that pre-existing disease. Therefore,...
The State Consumer Disputes Redressal Commission, Haryana bench of S.C. Kaushik (Member) held Max New York Life Insurance Co. Ltd liable for deficiency in services for dismissing a genuine claim based on non-disclosure of a pre-existing renal disease. The bench held that the Insurance Company failed to prove that the reason of death was due to that pre-existing disease. Therefore, it wrongfully repudiated the claim.
Brief Facts:
The matter pertained to a life insurance policy from Max New York Life Insurance Co. Ltd. (“Insurance Company”), purchased by Satbir Singh (“Deceased”), father and husband of the Complainants. Allegedly, upon his death, the claim was repudiated by the Insurance Company, stating non-disclosure of his medical history which included his condition of renal cell carcinoma. Feeling aggrieved, the Complainants approached the District Consumer Disputes Redressal Forum, Sonipat ('District Commission”) and filed a consumer complaint against the Insurance Company.
The insurance company, in response, contended that the deceased concealed his medical condition of kidney cancer, which was a material non-disclosure leading to the repudiation of the claim. It argued that the repudiation was justified per the terms of the insurance policy and that there was no deficiency in service.
The District Commission ruled in favour of the Complainants and directed the Insurance Company to pay Rs. 8,48,720/- to the Complainants. Dissatisfied with the decision, the Insurance Company approached the State Consumer Disputes Redressal Commission, Haryana (“State Commission”).
Observations by the State Commission:
The State Commission noted that neither the death certificate nor the treatment summary, nor the information provided by the attending doctor, Dr. Arun Garg, indicated that the deceased's cause of death was renal cell carcinoma. Instead, the documentation stated that he passed away due to sudden breathlessness and chest discomfort.
“However, it is nowhere mentioned in the death certificate or treatment summary as well as information sought by the Medical Officer, Max New York Life Insurance (appellant-OP) from treating Doctor Shri Arun Garg, who attended the deceased on 07.01.2011 that life assured (deceased) died due to Renal Cell Carcinoma i.e. kidney cancer, whereas, as per certificate issued by treating Doctor Shri Arun Garg, life assured (deceased) died due to sudden breathlessness and chest discomfort. Accordingly, in the absence of any evidence to prove the contentions of the insurance company, learned District Commission rightly observed that the insurance company wrongly repudiated the claim of complainant.”
Therefore, the argument of the Insurance Company, that the deceased passed away because of pre-existing undisclosed renal carcinoma, was rejected. Consequently, the State Commission dismissed the appeal filed by the Insurance Company and directed it to pay Rs. 8,48,720/- to the Complainants.
Case Title: The Branch Manager, Max New York Life Insurance Co. Ltd vs Sanjeet and Ors.
Case Number: First Appeal No. 287 of 2015
Advocate for the Appellant (Max New York Life Insurance Co. Ltd.): Shri Ravi Kant
Advocate for the Respondents/Original Complainants: Shri Vineet Chaudhary and Shri Shivam Chaudhary
Date of Order: 14th May 2024
