Insurance - Policyholder diagnosed with cancer during the waiting period of 180 days : Whether covered?

Kerala High Court Dismisses Insurance Claim, Upholds LIC's Waiting Period Clause. Court rules citing diagnosis during policy waiting period; no suppression of material facts found.

In a significant judgment, the Kerala High Court has ruled against the respondent, Haripreetha T, in a legal battle with Life Insurance Corporation of India (LIC) over a cancer cover policy claim. The Division Bench of Justices Anil K. Narendran and Muralee Krishna S. overturned the decision of a Single Judge, emphasizing the interpretation of the "date of diagnosis" within the context of the policy's waiting period clause.

Haripreetha T, the respondent, had taken a cancer cover policy from LIC in March 2021. After being hospitalized in August 2021, she was diagnosed with Endometrial Carcinoma. However, LIC rejected her insurance claim, stating the diagnosis fell within the 180-day waiting period stipulated by Clause 8(G) of the policy, thus disqualifying her from receiving benefits.

The case revolved around the interpretation of "date of diagnosis." The court examined various medical reports, including an ultrasound scan, histopathology, and MRI conducted within the waiting period, which suggested malignancy. A subsequent pathology report on September 28, 2021, confirmed the diagnosis. The court concluded that the diagnosis during the waiting period, not the final confirmation, determines eligibility under the policy.

On another contentious point, LIC alleged that Haripreetha had suppressed her mother's history of breast cancer, which could constitute a material fact. However, the court found no evidence of suppression, as the mother's cancer was detected over 30 years ago at the age of 74, which was deemed plausible and irrelevant to the policy terms.

The High Court's judgment reinstated LIC's original decision, highlighting the importance of adhering to policy conditions and waiting periods. The ruling underscores the necessity for policyholders to understand the implications of clauses like waiting periods in insurance contracts.

Bottom Line:

Interpretation of "date of diagnosis" in a cancer cover policy - Policyholder diagnosed with cancer during the waiting period of 180 days under the insurance policy - Held, final confirmation by a pathology report is not the first diagnosis; diagnosis during the waiting period disentitles the policyholder from coverage.

Statutory provision(s): Kerala High Court Act, 1958; Article 226 of the Constitution of India; Clause 8(G) of the LIC Cancer Cover Policy.

Life Insurance Corporation of India v. Haripreetha T, (Kerala)(DB) : Law Finder Doc Id # 2790093