Lucknow Consumer Commission Orders Bharti AXA to Pay Rs One Crore to Deceased’s Family

According to the complainants, Nirendra Kumar Dwivedi fell ill in July 2016 and was subsequently diagnosed with kidney and diabetes-related ailments. He was treated at ILBS, New Delhi, and Medanta Hospital, before passing away on December 14, 2017, due to brain haemorrhage. Claims under both policies were submitted in February and March 2018 but were rejected by the insurer on March 31, 2018. The company cited alleged non-disclosure of pre-existing diabetes, hypertension, and chronic kidney disease dating back years before the policy issuance.

The complainants contended that no such ailments existed at the time of policy proposals and that the insurer’s own pre-issuance medical reports were normal. They alleged deficiency in service and sought the sum assured under the first policy, endowment and maturity benefits under the second, and compensation for mental agony and litigation costs.

Bharti AXA argued that the insured had suppressed material facts about his health and that medical records from ILBS and Medanta indicated pre-existing serious illnesses. The company maintained that there was no deficiency in service. It also contended that a prior complaint on the same issue had been withdrawn and refiling with the same prayer was impermissible.

Presiding Member Amarjeet Tripathi, after reviewing affidavits, discharge summaries, medical reports, and policy documents, held that both policies were indeed issued after complete medical examinations conducted by Bharti AXA, with all reports normal at the time. The Commission noted that the insurer’s own rejection letter of April 2016 for a third proposed policy cited income-based grounds, not health concerns, further supporting the complainants’ case that no serious ailments were detected then.

On examining hospital records, the Commission, which also included Pratibha Singh, found that while the insured was diagnosed with chronic kidney disease, hypertension, and liver disease in late 2016, there was no evidence in the records that these conditions existed before July 2016. The discharge summaries and medical histories did not support the insurer’s claim of decades-long illnesses.

Citing the National Consumer Disputes Redressal Commission’s decision in LIC vs. Reena Nanda (2018), the Commission reiterated that when a policy is issued after an insurer’s own medical examination, the company cannot later claim non-disclosure of illnesses that were not detected by its appointed doctor. The insurer’s reliance on a Supreme Court decision in Reliance Nippon Life vs. M.L. Chaturvedi was held inapplicable, as the facts differed.

On the procedural objection regarding the earlier withdrawn complaint, the Commission referred to Indian Machinery Co. vs. Ansal Housing (2016), where the Supreme Court held that such prohibitions do not apply to consumer fora when a case was not decided on merits.