No insurance company can a refuse a mediclaim citing that the policy holder only disclosed certain medical conditions while signing up, the Supreme Court has ruled, PTI reported.

A bench of Justices DY Chandrachud and BV Nagarathna made the observations while hearing an appeal by a person named Manmohan Nanda, who had bought an Overseas Mediclaim Business and Holiday Policy before travelling to the United States.

After arriving at the San Francisco airport, Nanda suffered a heart attack and underwent an angioplasty. Three stents were inserted to remove the blockage from his heart vessels. Later, Nanda claimed the treatment expenses from the United India Insurance company but was told that he failed to completely disclose his health conditions.

The National Consumer Disputes Redressal Commission had also rejected Nanda’s plea seeking treatment expenses from the insurer, saying he did not disclose that he had been taking statin drugs while buying the mediclaim policy.

The National Consumer Disputes Redressal Commission said he failed to comply with his duty to make a complete disclosure of his health conditions. Nanda filed an appeal against the order in the Supreme Court.

At the hearing of the case, the Supreme Court said the United India Insurance company repudiating Nanda’s claims for treatment expenses was illegal and not in accordance with law.

“Once the policy has been issued after assessing the medical condition of the insured, the insurer cannot repudiate the claim by citing an existing medical condition, which was disclosed by the insured in the proposal form and which condition has led to a particular risk in respect of which the claim has been made by the insured,” the judges said.

The court said the purpose of buying a mediclaim policy is to seek indemnification for illness or sickness that is not expected and may occur overseas. “If the insured suffers a sudden sickness or ailment, which is not expressly excluded under the policy, a duty is cast on the insurer to indemnify the appellant for the expenses incurred thereunder,” the bench added.

Justices Chandrachud and Nagarathna also stated that the those signing up for mediclaim have to disclose to the insurer all material facts within his or her knowledge.