A widow has won a six-year legal battle to secure a ₹50 lakh life insurance claim after SBI Life rejected her husband’s death claim, citing undisclosed pre-existing health conditions. The Chandigarh State Consumer Commission ruled in favour of the claimant, finding that the insurer had relied on medical records that did not adequately establish deliberate concealment of a material illness.
The policyholder, Raj Kumar, a 36-year-old chartered accountant from Haryana, had purchased an SBI Life Smart Savadhan Plus policy in March 2019, naming his wife Anita Yadav as nominee. He died in October 2020 after experiencing sudden chest pain. SBI Life repudiated the claim in March 2021, referring to a 2014 hospitalisation for acute pancreatitis and delirium tremens, as well as a later medical record noting a cirrhotic liver.
The Commission observed that nearly four-and-a-half years separated the earlier hospitalisation from the policy commencement and held that the insurer had not sufficiently established intentional suppression of material facts. The decision underscores the importance of evidence-based claim assessment and the need for insurers to establish materiality and deliberate nondisclosure when repudiating life insurance claims.
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