Man wins Rs 60 lakh after Bharti AXA wrongly rejects son’s cancer death claim

‘Insurer trying to escape liability’

• In 2017, Amit Kumar (since deceased) purchased the insurance policy from the opposite party for the sum insured of Rs 60 lakh.
• The life assured expired on June 28, 2021, during the subsistence of the insurance policy.
• The opposite party (insurer) repudiated the complainant’s claim in June 2023 on grounds of non-disclosure of material information regarding the health of the DLA at the time of filling the proposal form, and concealing his pre-existing disease.
• The opposite party alleged that DLA was suffering from cancer prior to issuance of the policy, which was not disclosed in the proposal form, and the policy was obtained by non-disclosure of the material facts with the intent to defeat the company.
• The insurer alleged that DLA had not disclosed the material facts regarding his health and concealed the same while filling the proposal form, whereas the complainant has alleged that DLA had not concealed any facts with regard to his health and had specifically disclosed each fact with regard to his health.
• If the DLA had not disclosed the pre-existing disease in the actual proposal form, the insurer should have placed on file a copy of the said form filled and signed by the DLA.
• It has been, therefore, proved that the opposite party has prepared the alleged proposal form later on and placed it on the file, just to escape liability.

Policy purchase, treatment

• The son of the complainant, Amit Kumar, purchased a life insurance policy, Bharti AXA Life Flexi Term, from the opposite party, with a sum insured of Rs 60 lakh and a policy period of 60 years, and it was renewed from time to time by paying the premium. The complainant is the nominee in the said policy.
• Before taking the insurance policy, the son of the complainant had suffered from sudden onset dysphasia (impaired ability to speak, read or write) with weakness of the right upper limb.
• He took treatment in this regard from Max Super Specialty Hospital, Shalimar Bagh, New Delhi, where he was admitted on June 3, 2017.
• A surgery was done on June 5, 2017, and the patient was discharged on June 10, 2017, in a stable condition.
• According to the complainant, his son told the opposite party that he underwent the treatment at the time of purchasing the insurance policy, and the officials thoroughly examined his son through the doctors on their panel on June 29, 2017.
• After the examinations and recommendations of Dr Ravinder P Singh, regarding the son of the complainant being perfectly all right, the insurance company issued the life insurance policy.

Condition worsens, death in 2021

The complainant’s son suffered from stage Gliosarcoma (central nervous system tumour) with acute respiratory infection with septic shock, and was brought to Action Cancer Hospital, Delhi, where a brain MRI was done in November 2018, February 2019, and May 2020.

A Non-Contrast Computed Tomography (NCCT scan) and a brain MRI was carried out in October 2019. In 2020, Kumar was admitted for chemotherapy at Action Cancer Hospital. He tolerated the treatment well and was discharged the same day in a stable condition.

Kumar, however, did not recover from the disease and died in June 2021, during further treatment at the hospital.

After the death, the complainant applied for the claim amount of Rs 60 lakh and submitted all the required documents as per the instructions of the opposite party to settle the claim.

Thereafter, the complainant requested the insurer several times to settle the claim, but the opposite party extended the matter citing various pretexts before finally rejecting the claim, allegedly on false and frivolous grounds, via a letter dated June, 2023.

Policy taken to defraud: Insurer

The insurer argued that, as per the death summary, Kumar was regularly getting treatment for Gliosarcoma with acute respiratory infection with septic shock, but had not disclosed the fact at the time of proposing the policy.

It was alleged that the DLA and the complainant had taken the policy in question only to defraud the company.

Significance of ruling

This judgment reinforces that insurers cannot arbitrarily repudiate claims if they fail to produce authentic, signed proposal forms. It confirms that the burden of proof shifts to the insurer after two years, protecting consumers from unfair, “evasive” tactics used to avoid paying genuine life insurance claims.

Consumers facing similar grievances may contact the consumer helpline in their respective states (Haryana contact: 1800-180-2087) or dial the National Consumer Helpline at 1915 for assistance.