Insurer Cannot Repudiate Insurance Claim Based On Non-Disclosure After Issuing Policy: NCDRC Holds Care Health Insurance Liable For Deficiency In Service

The National Consumer Disputes Redressal Commission, headed by Dr. Inder Jit Singh, emphasized the insurer's duty to thoroughly assess the insured's medical condition before issuing a policy. Despite some columns being left blank, if the insured discloses existing medical conditions, the insurer cannot reject claims later citing non-disclosure. \r

In a case where the complainant declared a history of high blood pressure for five years, the insurer issued the policy upon receiving the premium. The commission stressed that the insurer should have requested completion of the form and conducted a medical examination, considering the complainant's age and medical history. \r

Reliance was placed on a Supreme Court judgment affirming insurers must gather medical details before issuing policies and cannot repudiate claims based on disclosed conditions. The National Commission upheld the state commission's ruling, dismissing the insurer's petition.