In a significant and pivotal decision that has reverberated across the insurance landscape, the National Consumer Dispute Redressal Commission (NCDRC) recently rendered a directive to the Life Insurance Corporation of India (LIC).
It concerned the honoring of nine insurance policies owned by Anil Patel, a domiciliary of Nadiad, Gujarat, despite non-disclosure of depression.
This landmark ruling from the commission held sway, despite LIC’s vehement assertion that Patel, at the time of purchasing the policies, deliberately concealed his ongoing battle with depression.
Tragically, Patel’s demise ensued as a result of a heart attack in the year 2012, a circumstance that LIC correlated with his purportedly undisclosed struggle with depression.
The central contention in this conflict was LIC’s denial to avail insurance benefits to Anil Patel’s bereaved family on grounds of his non-disclosure of depression.
According to LIC it is clear that Patel failed to give out important information about his medical background and treatment as required by Insurance Regulatory and Development Authority (IRDA) guidelines.
The guidelines are fundamental under the terms of an insurance contract hence doing non-disclosure of depression becomes foundation for denying claim posthumously made by LIC. Thus, LIC explained why it declined Anil’s family death claims upon his premature death.
However, NCDRC verdict fundamentally opposed this stand taken by LIC explaining that their literature did not categorize depression as severe or critical illness.
The commission further stressed out on depression as not having direct links towards any documented evidence which proved depression to be directly linked with heart failure.
In simple words, there was no tangible relationship between depression and cause of Anil Patel’s death—heart attack which led NCDRC to categorically instruct LIC’s fulfillment of insurance amounts due to Anil Patel’s family.
Anil Patel had initiated the acquisition of what would be nine new policies from LIC back in 2010 where he subjected himself through series of medical tests conducted by LIC appointed panel doctors.
LIC acknowledged this and consequently made additional premium payments owing to Patel’s excessive weight.
However, insurer argued that his non-disclosure of depression was a deliberate refusal even after the comprehensive physical evaluations done by their own appointed doctors.
The family stood firm in their belief that Patel’s depression had no direct connection with his death due to heart attack.
The Kheda district consumer forum together with Gujarat State Dispute Redressal Commission upheld these stances.
These courts had already directed LIC to process all the insurance claims of the Patel family.
However, in an astonishing verdict that has defied even LIC subsequent challenges to it lasting until 2019.
The response from Patel’s family to LIC’s assertions served to underscore a crucial contradiction stemming from the medical examinations conducted by LIC’s designated physicians.
This rebuttal effectively challenged the basis of LIC’s claims, indicating that any insinuation of information suppression on Patel’s part was unfounded and lacked substantial merit.
The family’s contention here is that the medical examination done by LIC doctors negates any assertions about non-disclosure of depression on behalf of Patel by proving conclusively that such imputations were baseless.
A significant turning point in the landscape of insurance claim adjudications is marked by the decision that the NCDRC has made.
It challenges the convention of denying insurance benefits upon non-disclosure of depression, marking it as a notable watershed moment.
Particularly striking is its examination of cases without direct proof that strongly relates a former illness for example depression and the specific cause of death in question.
It fundamentally questions the traditional approach that solely denies on non-disclosure basis, insisting on nuanced evaluation linking underlying health issues to actual cause of death before rejecting policy claims.
An influential pivotal precedent in this particular case underlines an extremely imperative need for a very thorough and comprehensive assessment.
Before insurance claims are flatly denied, it highlights the importance of scrutinizing carefully whether pre-existing health conditions had anything to do with dying eventually.
This is a landmark ruling that repeats and re-asserts the overriding significance of any findings being grounded in hard facts.
In addition, it frames firmly within ideals such as fairness, equal treatment, and justice dispensation when dealing with insurance claims.
