Tribune News Service

Saurabh Malik

Chandigarh, November 19

The Punjab and Haryana High Court has held that an insurance company need not invalidate a claim if it decides not to undergo a medical examination of the insured before issuing the policy.

This was because he had the opportunity to satisfy himself about the health and medical conditions of the insured and not to rely on his statement. The bench also made it clear that the claim cannot be dismissed on the ground of suppression of material information regarding the medical condition when the death was due to unrelated causes.

Obligations to pay

  • The High Court says that the claim cannot be dismissed on the basis of suppression of information
  • After exercising commercial prudence, the company cannot be allowed to escape responsibility
  • The insured was admitted to the hospital about four months before he received the policy

“Having exercised its commercial prudence, it should not be allowed to avoid its responsibility.” Having chosen not to subject the proposer to a medical examination, it can be safely assumed that such information was not grossly relevant to his decision or that the cost of a medical examination to ascertain the state of health was not worth the risk,” the Bench argued.

Justice Vinod S. Having chosen to waive her right to seek a medical examination, she could not be permitted to seek protection from the alleged suppression in all possible eventualities.

The question for adjudication before the Bench of Justice Bardwai was whether the insurance company would be entitled to reject the insurance claim on the basis of suppression of material information relating to the state of health where the death was wholly unrelated to it and was the result of a traffic accident. motor vehicle accident.

The bench of Justice Bhardwaj was told that the insured died in an accident in May 2013. The position of the insurance company, however, was that the dependent was not entitled to the claim for concealment of material information. It is reported that the insured was admitted to the hospital about four months prior to obtaining the policy with a diagnosis of accelerated hypertension and did not disclose the fact on his coronary angiography.

Justice Bhardwaj held that information can be categorized as “relevant” and “material”. Any information that is related to or related to the policy document can be classified as relevant. Material means all the essential information that is an integral part of the decision to take the risk.

Referring to the Supreme Court’s judgment, Justice Bhardwaj said he accepted the principle that the claim should not be struck down when the death was unrelated to the withheld information. Health information was intended to estimate loss of life due to disease, not an unrelated cause. The company had the right to request details regarding the health condition from its authorized doctors.

“As a prudent insurer, it should have sought verification of all health claims from its authorized physicians if any such facts were considered ‘material’ to its decision,” the court said. The claim awarded to the victim’s relatives was also upheld.



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