4 min readNew DelhiUpdated: Aug 21, 2026 04:20 PM IST
A Himachal Pradesh consumer commission has directed LIC to pay Rs 2 lakh in insurance along with Rs 25,000 compensation to a mother who was “harassed” by the company after the death of her son with Down syndrome due to COVID-19 infection in May 2021.
President Purender Vaidya, along with members Manchali and Jagdish Thakur, found that there was no specific medical evidence establishing that he had suffered from respiratory problems since childhood and allowed the mother’s complaint.
“In the absence of any specific and cogent evidence that complainant’s son was having any breathing/respiratory problem since his childhood, therefore, we are not in agreement with the plea of the opposite party (LIC) that the deceased had concealed his previous medical history of respiratory/breathing problem in the proposal form,” the August 7 order read.
Died during Covid-19
The woman claimed that her son was insured by LIC for Rs 2 lakh and the insurance cover commenced from November 15, 2020. She added that hat during pandemic of Covid-19 in May 2021, her son experienced some breathing problems and chest congestion, so he was taken to a government hospital for a check-up and from where he was taken to another hospital in an emergency, where there was no proper treatment for Covid-19. Consequently, when she was taking her son to a different hospital, her son died on his way on May 8, 2021.
The woman informed LIC of the death of her son and submitted all the documents regarding his insurance policy with the request to settle the claim, but the company allegedly repudiated the claim in November 2021. Aggrieved, she moved the commission and was represented by advocate Aditya Mohan.
‘No proof of respiratory problems’
The court found that the complainant’s son might have suffered from said Covid-19 infection during the Covid-19 threat in the year 2020-21. It held that the LIC failed to provide any evidence that suggests that the son had any breathing/respiratory problem since his childhood. Accordingly, it held that the complainant’s son had not concealed his previous medical history of respiratory/breathing problems in the proposal form.
It was clarified by the commission that the son was insured by the company for Rs 2 lakh and the complainant, being the mother, is entitled to get the said amount and directed LIC to pay the same.
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Noting that the lady was “harassed” by the insurance company and she was forced to file the present complaint, the commission directed the company to pay compensation of Rs 20,000 and litigation costs of Rs 5,000 to the woman.
LIC’s defence
The LIC, represented by advocate A L Nadda, argued that the complainant’s son was given treatment in one of the hospitals and he was a known case of Down’s Syndrome with a history of respiratory difficulty on and off since childhood.
However, the lawyer pointed out that, in the proposal form of the insurance policy, the son’s previous ailment history was not disclosed, and all the questions relating to his illness were answered in the negative. The lawyer claimed that the complainant deliberately suppressed information regarding her son’s previous medical history. It was further stated that, as per the record, he died on May 8, 2021, and hence the complainant was not entitled to get any claim amount.
Takeaway
This ruling highlights that an insurance company cannot reject claims on the basis of non-disclosure of previous ailment history unless it can prove the same.
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Aggrieved consumers may contact the consumer helpline in their respective states (Himachal Pradesh helpline: 1800–180–8087) or call the National Consumer Helpline at 1915 for assistance.
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