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Supreme Court of India 2019-04-15 allowed

Life Insurance Corporation of India vs Manish Gupta

Bench: 2 — Dr. Dhananjaya Y. Chandrachud

In Brief

The Life Insurance Corporation denied a mediclaim benefit for mitral valve surgery, arguing the insured had failed to disclose pre-existing rheumatic heart disease in the policy proposal form despite answering negatively to questions about cardiovascular disease. Consumer forums allowed the claim, reasoning the treating doctor's notes lacked direct patient testimony. The Supreme Court reversed this, holding that in a non-medical policy, the insured bears a solemn obligation of truthful disclosure. Non-disclosure of material health information constitutes fraud justifying repudiation. The insured's failure to disclose lifelong rheumatic heart disease was valid grounds to reject the claim.

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Insurance Law Consumer Protection Health Insurance Mediclaim Non-disclosure and Fraud Utmost Good Faith Pre-existing Conditions

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