In Brief
The appellant purchased an overseas mediclaim policy for travel to the USA and disclosed that he had diabetes mellitus-II. Medical tests showed normal results including a normal ECG. Shortly after arriving in San Francisco, he suffered an acute myocardial infarction and underwent angioplasty. The insurer repudiated the claim alleging non-disclosure of hyperlipidaemia (a pre-existing condition) because the appellant was on statin medication. The Supreme Court held that the insurer was not justified in repudiation. Since the insured disclosed his diabetes and submitted medical reports examined by the insurer before issuing the policy, the insurer must have assessed the risk and was bound by that decision. Statin prescription to a diabetic is a precautionary measure, not proof of hyperlipidaemia or cardiac disease. The Court allowed the appeal and directed payment of medical expenses plus interest and costs.
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