Page 56 - The Insurance Times May 2025

Insurance Caselaws

The NCDRC dismissed LIC's appeal and nee denied the claims on the grounds that the complainant
had withheld material information at the time of policy is-
directed it to pay the nominees Rs. 47.90 suance.
lakh.
The Life Insurance Company (LIC) provided nine life insur-
Case: Life Insurance Corporation of India vs. Dr. ance policies to Anil Kumar Patel, a native of Kheda,

Nilam Hetalkumar Patel & 4 Ors. Gujarat. Unfortunately, Mr. Patel died of a heart attack just
two years after obtaining these policies. After Mr. Patel
Summary passed away, his heirs, who were entitled to insurance pro-
ceeds, properly submitted claims for each of the previously
The Life Insurance Corporation of India (LIC) faced a deci-
stated life insurance policies.
sion from the Gujarat State Consumer Disputes Redressal
Commission (State Commission) that denied its appeal But since Mr. Patel had omitted important information from
against a ruling by the National Consumer Disputes
the policy's issuance, LIC denied the claims. After that, the
Redressal Commission (NCDRC). The NCDRC directed LIC to
Patel family went to the Kheda District Consumer Disputes
reimburse the complainant's nominees for Rs 47.90 lakh Redressal Forum (also known as the "District Commission")
after the complainant's nominee denied the claims on the
to fight for their rights, and the District Commission partially
grounds that the complainant had withheld material infor-
decided in favor of the nominees.
mation at the time of policy issuance.
Feeling let down by this result, LIC took legal action and
The Patel family had filed claims for the policies after Mr.
challenged the ruling in front of the Gujarat State Consumer
Patel died of a heart attack. The District Commission par- Disputes Redressal Commission (the "State Commission").
tially decided in favor of the nominees, but LIC challenged
However, their appeal was turned down. The National Con-
the ruling in front of the Gujarat State Consumer Disputes
sumer Disputes Redressal Commission ("NCDRC") received
Redressal Commission. The NCDRC, in agreement with the
an appeal from LIC as a final option.The complainants in this
State Commission, confirmed the decision, stating that an instance, Mr. Patel's nominees, argued that the medical
affidavit from the physician is not required when the insured
certificate regarding Mr. Patel's depression was not to be
party has given the insurance company permission to ob-
taken into consideration as proof. They made this claim
tain medical records from hospitals. because the certificate did not have the required affirma-
tion from the physician who had provided it.
About the case
The appeal filed by the Life Insurance Corporation of India The candidates also claimed that Mr. Patel had undergone
(LIC) against a Gujarat State Consumer Disputes Redressal medical exams by LIC's panel physicians prior to the policies
Commission ruling was denied by the bench of the National being issued, and they mentioned that Mr. Patel's obesity
Consumer Disputes Redressal Commission (NCDRC), which had resulted in an additional premium being charged. This,
is led by Inder Jit Singh, the Presiding Member. they claimed, proved there had been no hiding or repres-
sion of important information.LIC argued, however, that Mr.
The NCDRC directed LIC to reimburse the complainant's Patel had in fact withheld important information about his
nominees for Rs 47.90 lakh after the complainant's nomi- medical background and course of treatment. According to

The Insurance Times May 2025 51