Onus of proving pre-existing disease is on insurer: Court

BENGALURU: A consumer court pulled up HDFC Standard Life Insurance for denying a woman her husband’s death benefit, claiming that the man had concealed his health problems while opting for the policy.

The court ordered that the firm must pay her Rs 2,24,737 with interest, besides Rs 40,000 for causing her mental agony and another Rs 4,000 towards her court expenses.

Kanakapura resident Padma V’s husband Venkatesh died of a massive heart attack on October 30, 2014. A few weeks later, Padma gathered her husband’s HDFC Standard Life Insurance policy papers, worth over Rs 2.2 lakh, and applied for death benefits. But much to her shock, HDFC replied on January 27, 2015, turning down the death benefit claim as Venkatesh had a history of illness which he hadn’t disclosed in his policy application.

Padma tried to convince the insurer for nearly two years before approaching the 3rd Additional Bangalore Urban District Consumer Disputes Redressal Forum on September 27, 2016, with a complaint against the firm.

HDFC’s attorney slammed the case as frivolous and an illegal attempt towards monetary gain. He said the HDFC policy was issued to Venkatesh on September 13, 2014 and he knowingly penned ‘No’ in the column on the application form regarding diabetes, high blood pressure and heart condition, hiding his health parameters. A probe prior to issuing his death benefit money had ascertained that he had a history of illness and the money had been rightfully denied, the attorney added.

The consumer court slammed the insurance firm over its inability to prove Venkatesh’s history of illness. The judges said, as per the National Commission, the burden of proving that the policy holder had pre-existing illness is on the insurance company and not the insuree. Pre-existing illness can be determined only if the policy holder had been hospitalised or undergone surgery within the proximate period of the date of the policy. Moreover, the onus is on the insurance company to verify all the L facts mentioned in the application form before issuing the policy, and HDFC had in this case failed to do so.

Source: The Times of India