Insurer’s hidden illness excuse backfires: Consumer court orders Rs 50.60 lakh payout
to pay Rs 50.60 lakh as the claim amount and compensation.President Justice Malasri Nandi and member Tapas Kumar Ghosh were hearing the complaint filed by the son of the policyholder, who was also the nominee in the said policy, against HDFC Life over the rejection of his father’s insurance claim.“Due to their faulty findings and investigation, the complainant had to suffer a lot for his claim unnecessarily. Hence, such conduct of the opposite parties (HDFC) amounts to deficiency in their service,” the commission observed on 29 June, adding that the medical tests done before the policy was issued left no room for concealment. The commission found that the insurer’s own witness, a pharmacist at a rural health centre, could not confirm whether the earlier treatment records, which the insurer used to reject the claim, belonged to the same patient or not, and it was also noted that no doctor was even posted at the health centre at the time of the said medical records. Events leading to claim denial The counsel for the complainant, advocate G R Dutta, brought before the commission that the policyholder bought a policy, named HDFC Life Click-2 Protect Plus on 22 January, 2016 for an assured sum of Rs 50 lakhs, paying a premium of Rs 35,272. His son was named the nominee. The policyholder died on July 17, 2017, of aspiration pneumonia. His son filed the death claim in October 2017. Still, HDFC Life rejected it in December 2017, saying that he had suffered from hepatitis C and a cerebrovascular accident (stroke) before taking the policy and had not disclosed this. The insurer later said that the policyholder had answered “no” to questions in the proposal form about past illness and hospitalisation, which it called suppression of material facts. It also argued that only the policyholder’s legal heirs, not the nominee alone, could claim the money.Story continues below this ad Court rejects ‘hidden illness’ argument
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