Should LIC display a list of diseases which disqualify a proposer from availing insurance coverage?
The appellant had applied for insurance coverage under Jeewan Aarogya insurance plan of Life Insurance of Corporation (LIC) of India. He claimed that he had clearly disclosed the pre–existing disease of diabetes along with the medication being administered to him in his proposal form at the time of applying for insurance. However, he was asked to undergo other medical tests (which he complied with) and resubmit the proposal form. Subsequently, after the case was scrutinised by the Committee of Medical Referees, his case was turned down. The insurance company had deducted the expenditure on medical tests, processing fee and service charges from the lump sum amount deposited by the appellant. He filed an application under the Right to Information (RTI) Act with the LIC of India seeking details of the acceptance/ rejection of a proposal filed by the appellant and his wife for LIC Jeevan Arogya Policy. The Public Information Officer (PIO) provided some information to the appellant.
During the hearing the before Central Information Commission (CIC), the appellant pleaded that the LIC of India must disclose to him and also put on their website if not an exhaustive list, at least an illustrative list of diseases on account of which proposal for coverage under the above mentioned health insurance plan will be turned down. The PIO stated that this is privileged information and cannot be disclosed as they form part of the underwriting rules and guidelines of LIC of India which are confidential and can not to be disclosed.
View of CIC
The Commission directed the PIO to facilitate inspection of the complete file in which the case of the appellant has been examined and subsequently turned down. The Commission accepted the arguments put forth by the appellant that the list of pre– existing diseases which disqualify a proposer from availing of insurance coverage under Jeewan Aarogya insurance scheme must be placed on the website of the Corporation which will work as a guide to the clients of the Corporation. The CIC further held that it would also obviate the necessity of proposers having to unnecessarily undertake medical tests when they already stand ineligible for coverage of the above mentioned health insurance scheme due to a preexisting illness/ disease and bear unnecessary expenses there on.
Citation: Mr. M.K. Sasidharan v. LIC of India in Appeal: No. CIC/DS/A/2012/001474
RTI Citation : RTIFI/2013/CIC/1189
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