In Brief
A man obtained a mediclaim policy under the 'Non-Medical General' category and later claimed reimbursement for heart surgery (Mitral Valve Replacement). The insurer repudiated the claim, citing that the insured had non-disclosed pre-existing rheumatic heart disease since childhood. Consumer authorities allowed the claim, reasoning the treating doctor had not been examined. The Supreme Court reversed this, holding that the insured's failure to disclose the cardiovascular condition in the proposal form—despite being specifically asked—breached the duty of utmost good faith required in insurance contracts. The repudiation was valid under the policy's exclusion clause for pre-existing conditions.
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