Top court observes he failed to disclose pre-existing illness; the policy was issued for ?1.6 lakh Noting that a contract of insurance involves “utmost good faith”, the Supreme Court has denied medical insurance claim of a man who did not disclose past history of a disease he was suffering while buying the policy. A Bench of Justice D.Y. Chandrachud and Justice Hemant Gupta said: “The failure of the insured to disclose the past history of cardiovascular disease was a valid ground for repudiation.” Manish Gupta had obtained a mediclaim policy from Life Insurance Corporation of India (LIC) in June 2008. The policy was issued under the category of Non-Medical General (NMG) for a sum of ?1.6 lakh. The proposal form required a disclosure of health details and medical information. Among them was whether Mr. Gupta had suffered from cardiovascular disease like palpitations, heart attack, stroke or chest pain. He denied having any of the above ailments in the form. The next year, he submitted a claim after undergoing a Mitral Valve Replacement (MVR) surgery. The claim was denied by LIC on the ground that he was suffering from a pre-existing illness. ‘Pay ?2.21 lakh’ When challenged LIC’s decision before the District Consumer Disputes Redressal Forum, Ambala, which pass an order in his favour. The District Forum directed LIC to pay a sum of ?2.21 lakh with interest. This order was concurred by the State Consumer Disputes Redressal Commission and later by the National Consumer Disputes Redressal Commission. LIC subsequently moved the apex court. Before the top court, LIC submitted that the Health-plus policy falls under the NMG category where the insured is not subjected to a medical examination before the issuance of the policy. It argued that the onus was on the insured to provide material particulars of his health since no medical examination was mandated. Mr. Gutpa argued that he was not suffering from any other ailment and that he cannot be faulted for any noting which has been made by the doctor in the course of treatment. But the Bench pointed out that the treatment record indicates that Mr. Gupta was operated for MVR, the nature of the diagnosis was rheumatic heart disease. Dismissing the orders of the consumer courts, the Bench said they have made a fundamental error in allowing the claim for reimbursement of medical expenses in the face of the uncontroverted material on record. “The documentary material indicates that there was a clear failure on the part of the respondent to disclose that he had suffered from rheumatic heart disease since childhood. The ground for repudiation was in terms of the exclusions contained in the policy,” it said.