The Life Insurance Corporation of India (LIC) has been directed to pay ₹5 lakh to the father of a deceased policyholder after a consumer commission found that the insurer had not provided sufficient evidence to support its rejection of the death claim on grounds of non-disclosure of a heart condition.
The case involved a 30-year-old policyholder who died of a heart attack. LIC rejected the claim, alleging that the deceased had failed to disclose a congenital heart condition, described as a “hole in the heart,” while purchasing the policy. According to the insurer, the policyholder had undergone a closure procedure for an atrial or ventricular septal defect in 2008.
The father challenged the repudiation before the consumer forum. The dispute centred on whether LIC had established, through reliable medical evidence, that the alleged condition existed and had been knowingly withheld when the policy was taken.
The District Consumer Disputes Redressal Commission, Sri Muktsar Sahib, comprising President Ashok Kumar Garg and Member Tajinder Kaur, ruled in favour of the complainant. The commission held that LIC’s rejection was erroneous and amounted to deficiency in service. The order was issued on September 1, 2026.
In addition to the ₹5 lakh claim amount, the commission awarded ₹10,000 towards compensation and legal expenses to the father.
The case highlights the importance of evidence-based claim repudiation. An insurer alleging non-disclosure of a material medical condition needs to establish the factual basis for that allegation rather than relying only on an inference from later medical information.
For insurers, the case reinforces the importance of maintaining adequate medical documentation and demonstrating the relevance of the alleged non-disclosure when rejecting a death claim.
For policyholders, the case also underlines the importance of providing complete and accurate health information at the proposal stage. Medical history that may affect underwriting should be disclosed clearly to avoid disputes later.
The ruling adds to a series of recent consumer-forum decisions involving insurance claims where allegations of pre-existing conditions or non-disclosure have been examined closely. In such disputes, the quality of medical evidence and the connection between the alleged condition and the claim can become central to the outcome.
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