MANMOHAN NANDA versus UNITED INDIA ASSURANCE CO. LTD. & ANR

MANMOHAN NANDA versus UNITED INDIA ASSURANCE CO. LTD. & ANR

Because the appellant disclosed diabetes mellitus-II and submitted normal ECG and test reports which were considered by the insurer before issuing the overseas mediclaim policy, the insurer, having issued the policy after assessment, could not repudiate the claim by treating the subsequent acute myocardial infarction as a pre-existing related complication; the exclusion clause must be construed contra proferentem and the insurer is liable to indemnify the appellant.

Parties
Appellant: MANMOHAN NANDA; Respondent: UNITED INDIA ASSURANCE CO. LTD.; Respondent: ANR
Jurisdiction
India
Judgment Date
06 December 2021
Procedural Posture
Civil Appeal / Appeal From Order Dated 22.05.2015 of the National Consumer Disputes Redressal Commission in Consumer Complaint No.92/2010
Outcome
Appeal allowed
Legal Topics
Repudiation for Non Disclosure, Pre Existing Condition Exclusion, Utmost Good Faith (uberrimae Fidei), Contra Proferentem, Materiality of Disclosure
Insurance Law Consumer Protection Contract Law Health/medical Insurance Repudiation for Non Disclosure Pre Existing Condition Exclusion Utmost Good Faith (uberrimae Fidei) Contra Proferentem +1 more

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Parties

MANMOHAN NANDA

Appellant

UNITED INDIA ASSURANCE CO. LTD.

Respondent

ANR

Respondent

Procedural Posture

Civil Appeal / Appeal From Order Dated 22.05.2015 of the National Consumer Disputes Redressal Commission in Consumer Complaint No.92/2010

Legal Issues

  1. 1 Whether the insured suppressed or failed to disclose material facts in the proposal form
  2. 2 Whether insurer could repudiate claim after assessing medical reports and issuing policy
  3. 3 Whether acute myocardial infarction on arrival abroad was a pre-existing condition excluded under the policy

Ratio Decidendi

Because the appellant disclosed diabetes mellitus-II and submitted normal ECG and test reports which were considered by the insurer before issuing the overseas mediclaim policy, the insurer, having issued the policy after assessment, could not repudiate the claim by treating the subsequent acute myocardial infarction as a pre-existing related complication; the exclusion clause must be construed contra proferentem and the insurer is liable to indemnify the appellant.

Court Disposition

Appeal allowed

Orders

  • Respondents directed to indemnify the appellant for expenses incurred towards medical treatment within one month of receipt of copy of judgment with interest at 6% per annum from the date of filing the claim petition before the Commission till realisation.
  • Conversion of US Dollar claims to Indian Rupees to be reckoned at the exchange rate as on the date the claim petition was filed before the Commission or at Rs.45 per USD, whichever is lesser.