Insurance claim rejected for ‘hiding’ teen’s sickle cell disease, family wins Rs 7 lakh relief

“The burden was on the insurer to establish that the insured had been suffering from the disease before obtaining the policy and had deliberately concealed it. In the absence of convincing medical evidence, repudiation of the claim amounts to deficiency in service,” the commission said on July 2, directing India Post to pay the insured amount along with compensation and litigation costs.

The dispute arose after the family lost their son, Devesh Sahu, just months after he purchased a Rural Postal Life Insurance policy. What followed was a prolonged fight over whether he had hidden a pre-existing illness, a question that ultimately determined whether his family would receive financial support promised under the policy.

Insurance purchase, tragedy in months

According to the complaint, Devesh purchased the RPLI Santosh Endowment Assurance policy on December 20, 2023. The proposal was accepted on April 26, 2024, and the policy provided a life cover of Rs 7 lakh. He paid an annual premium of about Rs 15,155, while his mother, Shanti Bai, was nominated as the beneficiary.

Tragedy struck on August 6, 2024, when Devesh died unexpectedly at the age of 19. His family submitted a claim under the insurance policy, expecting the promised financial assistance.

However, on November 11, 2025, India Post rejected the claim alleging that Devesh had been suffering from sickle cell disease since childhood but had falsely declared in the proposal form that he was healthy. It argued that this amounted to suppression of a material fact, making the policy void.

The parents denied that their son had knowingly concealed any illness. They said no document showed that he had been diagnosed with sickle cell disease before purchasing the insurance policy and that while hospital records prepared after his death referred to a sickle cell crisis, they did not establish that he had been suffering from the disease before taking the policy.

Gaps in insurer’s claims

The commission found significant gaps in the insurer’s case. Although India Post relied on an internal inquiry claiming that Devesh’s father had stated his son suffered from sickle cell disease since childhood, the commission noted that the alleged statement was never produced before it.

More importantly, the department failed to place on record any medical documents proving that Devesh had been diagnosed before he filled out the proposal form on December 20, 2023. The available hospital records merely mentioned a suspected ‘sickling crisis’ at the time of his final admission and did not indicate how long he had suffered from the condition.

The commission observed that the burden of proving suppression of a pre-existing disease rested on the insurer. Since India Post could not discharge that burden, rejecting the insurance claim amounted to deficiency in service. It also referred to judicial precedents holding that insurers cannot reject claims merely on allegations of non-disclosure unless supported by credible evidence.

Rs 7 lakh relief

Allowing the complaint partly, the commission directed India Post to pay the insured amount of Rs 7 lakh to the nominee within 45 days. It also awarded Rs 30,000 towards compensation for mental agony and Rs 5,000 as litigation costs. If the payment is not made within 45 days, the entire amount will carry interest at 7 per cent per annum from the date of the order until payment.

The ruling reinforces that an insurer cannot reject a life insurance claim simply by alleging that the policyholder concealed a pre-existing illness. It makes it clear that the insurer bears the burden of proving, with medical evidence, that the disease existed before the policy was purchased and was deliberately suppressed.

For consumer-related grievances, individuals may contact the consumer helpline in their respective states (Chhattisgarh: 1800-233-3663) or call the National Consumer Helpline at 1915 for assistance.