BENGALURU: Ruling that an insurance company cannot repudiate a claim for non-disclosure of a pre-existing disease, a consumer disputes redressal forum in the city ordered the Birla Sun Life Insurance Company Limited (BSLICL) to pay Rs 15 lakh insured amount with Rs 10,000 litigation cost, to the complainant, K Leela, resident of Manjunatha Layout in city.
Bengaluru II Additional District Consumer Disputes Redressal Forum, comprising president T Shobhadevi, members Balakrishna V Masali and V Anuradha, said that it is the duty of the insurance company to check the background of the insured, rather than making the nominee run from post to pillar.
“Most people are unaware of the symptoms of the disease they suffer. The insurance company relies on the terms and conditions of the policy in a malafide manner. No claim is payable under the mediclaim policy, as every human being is born to die and diseases are pre-existing in the system, which he is genuinely unaware of,” the forum said.
According to the order, Leela’s husband availed a housing loan of Rs 15 lakh from Can Fin Homes Limited, to buy a house. Leela, who was co-applicant, availed a life insurance policy from Birla Sun Life Insurance, to cover the entire value of the loan, on July 21, 2012. While processing the loan and insurance, BSLICL had carried out the required background and health check of the insured, and the premium amount was paid accordingly.
On November 21, 2011, Leela’s husband died due to an unexpected illness. To her surprise, the BSLICL allegedly created problems and wanted to repudiate the claim on February 28, 2013, when she approached them for the same. Hence, she moved the forum to clear the balance loan to be paid to Can Fin Homes Limited.
However, the BSLICL filed objections, stating that the they had not disclosed that he had undergone a surgery three years back, and he was diagnosed with cholithiasis. Hence, the claim was rightly repudiated on the grounds of ‘Suppression of Material facts’, it claimed.The complaint against Can Fin Homes is dismissed, stating that it has nothing to do with the insurance policy, and it is the full responsibility of the insurance company and the policyholder.