Insurance Claim Cannot be Denied Unrelated Health Issues, Chandigarh State Commission Holds Bajaj Allianz Life Insurance Liable (Consumer Case)
The Complainant’s mother took a personal loan from Bajaj Finserv, which included a complimentary Group Term Life Insurance policy from Bajaj Allianz for RS. 3,50,000. After the mother’s death due to sepsis in December 2020, Bajaj Allianz rejected the claim, citing non-disclosure of diabetes and hypertension.
Bajaj Finserv denied involvement in the claim rejection, while CPP Group India, the facilitator also denied responsibility. The District Commision ruled in favor of the complainant, ordering Bajaj Allianz to pay RS. 3,50,000 with interest, compensation, and litigation costs. Dissatisfied, the insurer appealed the decision to the State Commission.
The Commission noted that while the complainant’s relatives confirmed the deceased had medical issues, there was no documentary evidence linking these conditions to the time of insurance enrollment. Since the pre-existing conditions were not related to the cause of death, the Commission referenced a previous ruling stating that claim reputation is unjustified when a pre-existing condition is not the cause of death.
It also upheld the District Commission’s finding that the insurer’s failure to conduct a prior medical examination before issuing the policy was a deficiency in service Consequently, the State Commission dismissed the appeal and affirmed the District Commission’s decision.
Source: – Live Law
By: – Rajat Ranjan
