Topic
Bombay HC clarifies that the 12-month suicide exclusion period under life insurance policies begins from the date of policy lapse, not revival. The ruling entitles the nominee to the full sum assured if suicide occurs beyond 12 months from lapse, even if within 12 months of revival, impacting policyholders and insurers on contract interpretation.
The Punjab & Haryana High Court has ruled that insurers cannot deny health claims based on speculative inferences about pre-existing conditions when no medical documentation supports the allegation at the time of denial. This sets a critical precedent protecting policyholders from arbitrary rejections and reinforces that exclusions must be explicitly stated, not inferred.
Punjab & Haryana High Court rules that persistent symptoms like pain and swelling, without a confirmed medical diagnosis, cannot be classified as a pre-existing condition under health insurance policies. The judgment reinforces that insurers must base exclusions on formal diagnoses, not clinical symptoms alone, impacting claim settlements for policyholders.
The Punjab & Haryana High Court ruled that approaching the Insurance Ombudsman-classified as a 'Court' under Section 2(1)(aaa) of the Legal Services Authorities Act-before filing a dispute with the Permanent Lok Adalat extinguishes the PLA’s jurisdiction. This holding reinforces the mandatory pre-litigation exhaustion requirement under Section 22C, impacting consumers seeking redressal under alternative dispute resolution mechanisms.