Thursday, August 29, 2013

Hiding health facts may result into repudiation of claims

The Goa State Consumer Disputes Redressal Commission has reversed the order of the North Goa District Consumer Disputes Redressal Forum which ordered the SBI Life Insurance Company to honour the Insurance claim of a deceased person who hailed from Marcel in Ponda taluka.

The SBI Life had repudiated the claim on the basis that the deceased had withheld the facts that he was suffering from diabetes and was chronic alcoholic. The Goa State Consumer Disputed Redressal Commission has brushed aside the complaint against the bank.
The deceased had taken a house loan of Rs 10 lac from the St. Estevam branch of the State Bank of India in January 31, 2008. The deceased had also taken a group insurance policy from the bank meant for housing loan borrowers of SBI. Though the deceased had submitted a good-health declaration to avail of the policy, the policy stipulated that the assurance would be null and void, if any incorrect averments were made or if any information was suppressed.

 In October 2008, the deceased was admitted to a hospital where he diagnosed with cirrhosis of liver and his past history was recorded as a 'known case of diabetes mellitus on regular treatment'. He was then admitted to other hospital for further treatment. Here it was noted that the deceased had a history of diabetes, was a smoker and chronic alcoholic for 20 years. He expired on November 7, 2008. The hospital's death summary listed a long list of medical conditions including 'alcoholic liver disease'.

The nominee, wife of the deceased filed an insurance claim but the insurer rejected the claim stating that the deceased had given a false good health declaration at the time of entering into the insurance scheme. The wife approached the district forum which ruled in her favour. The bank then appealed before the Goa State Consumer Disputes Redressal Commission. The commission observed that the deceased has suppressed the facts and gave false answers to obtain the policy. The commission termed it a fraud case because the insured despite being a regular smoker, a drinker for 20 years, a diabetic for three years on medication who eventually died of cirrhosis of the liver, had withheld the facts at the time of signing the policy. 

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