RELIGARE HEALTH INSURANCE CO. LTD. Vs. JARNAIL SINGH

JUDGEMENT

(1.) The Insurance Company has come up assailing the order of the District Commission dtd. 21/6/2021 passed in CC/965/2018, whereby the complaint of the respondent claiming group insurance indemnification has been allowed and the appeal filed by the Insurance Company was disposed off partly modifying the order of the District Commission in FA/297/2021 vide order dtd. 19/4/2022.

(2.) The Insurance Company alleges that the insured had suppressed a material fact with regard to his ailment of hypertension that pre-existed prior to the issuance of the policy and therefore was a breach of the terms of the policy and consequently the claim was not indemnifiable. The policy was accordingly cancelled and no claim was indemnifiable to the complainant.

(3.) The background in which the claim had been made is that the complainant's medical risk was covered under a group health insurance policy acquired from the petitioner for which an annual premium of Rs.15,391.00 had been paid. The policy for the period in question was valid from 12/12/2017 till 11/12/2018 subject to the terms and conditions thereof for the sum assured @ Rs.5,00,000.00 each.