Page 57 - The Insurance Times May 2025

LIC, the insurance claims were repudiated because of this the insurance company could use its discretionary powers
non-disclosure. They maintained that, in light of Mr. Patel's to intervene and lessen the situation.
failure to disclose pertinent facts, the allegations might le-
gitimately be retracted. About the case
Recently, the Madras High Court ordered the SBI Life Insur-
In the State Commission hearings, Mr. Patel's nominees
ance Company to pay the claim amounts to the family of a
contended that a medical certificate regarding his depres-
man who had missed premium payments due to hospital-
sion was not to be taken into consideration as evidence since ization.
the physician who gave it did not provide an affidavit. How-
ever, the certificate was admitted into evidence by the State
The non-payment was due only to the insured's hospitaliza-
Commission. This decision was confirmed by the NCDRC in tion, treatment, and later death, according to Judge SM
agreement with the State Commission.
Subramaniam, who further noted that the default was nei-
The Supreme Court's ruling in Satwant Kaur Sandhu vs. The ther deliberate nor willful.Ramesh, the spouse of the peti-
New India Assurance Co. Ltd (2009) 8 SCC 316, which tioner, purchased a Rs. 18,40,000 life insurance policy and
stressed that an affidavit from the physician is not required paid the payments on time and without fail between Octo-
when the insured party has given the insurance company ber 2017 and January 2020.
permission to obtain medical records from hospitals, was
cited by the NCDRC. As a result, the NCDRC determined that Ramesh's health deteriorated in February 2020, leaving him
the certificate ought to be accepted. For this reason, the immobile and unable to carry out daily tasks. Following his
NCDRC denied the LIC's appeal and mandated that it pay hospitalization, Ramesh passed away in March 2020.The
the nominees of Mr. Patel a total of Rs. 47.90 lakh. insurance company disagreed, arguing that Ramesh was not
entitled to the covered sum because he had neglected to
Despite the policyholder's nonpayment pay premiums for the months of February and March 2020.

of premiums, the Madras High Court has As a result, the claim was properly denied. It was addition-
ordered the family to receive the life ally argued that there was no infirmity because the cover-
age had expired.The petitioner's husband's illness and hos-
insurance amount "due to ill-health." pitalization were the reason for the premium payment de-

fault, the court observed. The court further stated that it
Case Title: R Sasikala Devi v The AAO/ Assis-
was unreasonable to expect the insured to pay the out-
tance Secretary and others standing premiums on time while the family was experienc-
ing financial hardship.
Summary
The Madras High Court has ordered the SBI Life Insurance The insurance company was required to adhere to the court's
Company to pay a claim amount to the family of a man who terms and conditions, but the court also stated that the firm
missed premium payments due to hospitalization. The non- could use its discretionary powers to intervene and lessen the
payment was attributed to the insured's hospitalization, situation.Determining that the situation was exceptional, the
treatment, and later death, according to Judge SM court noted that the petitioner was qualified for the remedy
Subramaniam. Ramesh, the spouse of the petitioner, had based on equity. As a result, the court ordered the insurance
paid the premiums on time between October 2017 and Janu- firm to pay the debt in full within four weeks.
ary 2020.
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However, Ramesh's health deteriorated in February 2020,
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The insurance company argued that Ramesh was not en-
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52 May 2025 The Insurance Times