Case Law Details
Manjula Vs PNB Metlife India Insurance Co. Ltd. & Anr. (NCDRC Delhi)
Conclusion: In present facts of the case, the NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NEW DELHI (NCDRC) observed that if there was no nexus between the material fact / disease, which was not disclosed, and the cause of death, the insurance company’s action of repudiating the claim on the ground of suppression of material facts / non disclosure of pre-existing ailment is not correct.
Facts: In present facts of the case, the present Revision Petition was filed by the Petitioner against Respondents as detailed above, under section 58 (b) of Consumer Protection Act 2019, against the order dated 28.07.2021 of the State Consumer Disputes Redressal Commission, Karnataka.
Brief facts of the case were that the complainant’s husband Mr. Raju Malladihali had obtained the Met Family Income Protect Plus Policy for a sum assured of Rs.12,00,000/- on 09.02.2015 with a premium of Rs.15,846/- per annum. The complainant was the nominee to the insurance policy. On 08.03.2016 the insured passed away. The complainant, being the nominee of the insurance policy, submitted a claim on 20.06.2016 along with death certificate and other relevant documents to the OP, as the Policy was still in force. The Respondents neither responded nor paid the claim to the complainant despite repeated requests. The complainant sent a legal notice to the Respondents on 21.07.2018. The Respondent did not respond to the legal notice. On 23.07.2018, the complainant sent reminders on 23.07.2018 and 24.08.2018 for disbursement of the claim.
Respondent sent a very cryptic and ambiguous reply to the Petitioner stating that claim has been rejected. On 21.11.2018 the complainant approached the Insurance Regulatory Development Authority (IRDA), after being aggrieved by the conduct of the Respondent and also with the intent of avoiding cumbersome court proceedings. The IRDA after communicating with the Respondent replied to the complainant through mail that her claim is rejected on the ground that the deceased husband of the complainant had not disclosed a pre-existing medical condition of having chronic alcohol dependency and delirium tremens. Thus, he suppressed material information at the time of buying the insurance policy. Hence, the complainant filed a complaint before the District forum on 11.01.2019.
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