The Delhi State Consumer Disputes Redressal Commission has ruled in favor of a Delhi woman in a life insurance claim dispute case. According to reports from The Economic Times, the commission observed that common lifestyle diseases like diabetes or hypertension alone cannot justify claim rejection without strong evidence showing intentional misrepresentation. The ruling establishes important precedent for insurance claim disputes involving pre-existing medical conditions, with the commission determining that the insurer's repudiation was legally unsustainable and procedurally unfair.
The case involved Ms Kain and her late husband, who had taken a life insurance policy from IndiaFirst Life Insurance Company under the IndiaFirst Group Credit Life Plan. As reported by The Economic Times, the policy was linked to a loan from Bank of Baroda and started on June 20, 2012. The sum assured was ₹20 lakh and the premium amounted to ₹56,011. The policyholder died in February 2014, after which his wife filed the insurance claim, which was rejected by the company citing non-disclosure of medical conditions.
The insurer rejected the claim, stating that the deceased had not disclosed key medical facts at the time of buying the policy, including having Type-2 diabetes and taking insulin injections. According to The Economic Times, the insurer claimed the deceased had chronic kidney disease and was already on continuous peritoneal dialysis from March 2012. The company argued that if these details had been disclosed, the policy would never have been issued, violating policy terms and exclusions that were not properly explained to the family. However, the commission found that the insurer failed to produce proper documentary evidence proving deliberate concealment, with the investigation report being largely based on hearsay.
The commission ordered the insurer to pay the ₹20 lakh sum assured as well as 6% annual interest from November 10, 2014 to April 24, 2026. As reported by The Economic Times, the insurer was also instructed to pay ₹1 lakh for mental agony and harassment and ₹50,000 as litigation costs. The commission added that if payment was delayed beyond two months, the insurer would be liable to pay 9% interest until full payment. The insurer has filed an appeal before the National Consumer Disputes Redressal Commission, stating it will pursue appropriate legal remedies.
According to Advocate Mayank Arora from The Chambers of Bharat Chugh, the commission found that the insurer had failed to prove its allegation with cogent medical evidence. The absence of a clear nexus between alleged pre-existing diseases and the cause of death was a crucial factor in the ruling. Legal experts emphasize that diabetes, hypertension and similar lifestyle conditions are extremely common and cannot automatically become weapons to defeat genuine claims. The insurer's 213-day delay in claim rejection also violated the 90-day IRDA limit, while it never supplied the policy's terms and conditions to the policyholder.
