Kathmandu. KATHMANDU: Life Insurance Corporation of Nepal (LIC Nepal) has rejected a case filed by an insured party claiming that it has concealed health records related to high blood pressure.
KATHMANDU: The Patan High Court has dismissed the appeal filed by the Nepal Insurance Authority (NIA) in favour of the insured and upheld the decision of the insurance company to pay the claim to the insured’s wife. Anju Tuladhar, wife of Shivaram Shrestha of Kathmandu, died on December 25, 2020 and his wife Anju Tuladhar had filed a claim of Rs 5 million for the insurance premium. However, the insurance company refused to pay the claim, accusing the insurer of hiding the details of high blood pressure for 10 years.
The insurance company had approached the Patan High Court after the Insurance Authority of Nepal (IA) ordered to pay the death claim. A division bench of Justices Ramesh Raj Pokharel and Durga Prasad Dhungel on August 26, 2005 upheld the decision of the authority to pay the insurance amount as the medical report of the insurance company itself showed blood pressure to be normal at 130-80.
Although LIC Nepal has claimed that Shivaram Shrestha has been suffering from high blood pressure for the past 10 years, it has not been able to provide concrete evidence that he was diagnosed and treated for the disease before the insurance policy was issued. The court held that although the report of Norvic Hospital mentioned that he had high blood pressure for the past 10 years, the same document mentioned that he had not taken medicine and started taking HTN medicine only later.
According to the confidential report of the doctor of the company before the insurance, the blood pressure of the insured was found to be normal and the ECG of Sagarmatha Polyclinic was normal. The company has issued an insurance policy of Rs. 50 lakhs to the insured after conducting a thorough physical examination. The court held that since it had issued 110066939, it could not be withdrawn from the agreement at a later date.
This case has sent a message that the insurer should pay close attention to the health report and health condition of the proposer while making insurance and assessing the risk. Before accepting the offer, the insured should thoroughly analyze the health check-up, pre-existing condition and medical report of the insured. Because, once the insurance policy is issued, the insurer cannot reject the claim payment on the basis of mere conjecture without clear and substantiated grounds.
On the other hand, the insured should also clearly disclose his/her personal health history, past or current illnesses and medication intake while filling up the life insurance proposal form. Copies of health check-up reports and documents submitted during the insurance proposal should be kept safely.
