Date Of Final Opinion In Pathology Report Is Not First Date Of Cancer Diagnosis: Kerala High Court Allows LIC's Appeal Against Woman Claiming Cancer Cover Insurance

The Kerala High Court held that the final opinion arrived at by the pathology report is the confirmation of the diagnosis and it is not the first date on which cancer has been diagnosed.

The High Court allowed the Writ Appeal filed by LIC challenging the order of Single Judge, whereby LIC was directed to pay insurance claim to woman, who was diagnosed with cancer, within 180 days from taking the policy.

The Bench of Justice Anil K. Narendran and Justice Muralee Krishna S. observed, “This shows that the final opinion arrived at by the pathology report dated 28.09.2021 is the confirmation of the diagnosis made in Exts.R1(b) to R1(d) documents. This diagnosis, done on 28.09.2021, is the confirmation by an expert, and it is not the first date on which cancer has been diagnosed. In such circumstances, it can only be said that the diagnosis of cancer was within the waiting period of 180 days. Therefore, the 1st respondent is not entitled for the policy coverage as rightly contended by the appellant and found by the learned Ombudsman.”

Advocate Harish Gopinat represented the Appellant, while Advocate K.Balachandran represented the Respondents.

Case Brief

A Writ Appeal was filed by LIC challenging the judgment passed by a Single Judge. The Respondent contended that she took LIC’s Cancer cover policy for Rs. 10,00,000/-. In 2021, the Respondent was diagnosed with the disease Carcinoma Endometriosis Grade II and thereby, she submitted a claim petition.

However, the LIC rejected the claim stating the reason that the first diagnosis of ‘any stage of cancer’ was during the waiting period of 180 days mentioned in Clause 8(G) of Part C, from the date of policy. The Writ Petition filed by the Respondent was allowed by a Single Judge of the High Court.

Resultantly, a Writ Appeal was filed by LIC. It was the contention of the LIC that as per the policy, there was a waiting period of 180 days, and the benefit covered under the policy was not applicable during this period. The policy would automatically stand terminated if any stage of cancer was diagnosed before the expiry of this waiting period of 180 days.

Court’s Observation

At the outset, the High Court referred to the contents of the insurance policy. The Court noted that there was a waiting period for availing the benefit of the policy, which says that a waiting period of 180 days will apply from the date of issuance of the policy or date of revival of risk cover whichever is later, to the first diagnosis of "any stage" cancer. "Any Stage" was defined as all stages of Cancer that occur during the waiting period.

The Court opined that the prime issue involved in this case was the date of diagnosis of cancer.

The Court held that confirmation of diagnosis by an expert could not be the first date on which cancer has been diagnosed. “ In such circumstances, it can only be said that the diagnosis of cancer was within the waiting period of 180 days. Therefore, the 1st respondent is not entitled for the policy coverage as rightly contended by the appellant and found by the learned Ombudsman”, the Court held.

Accordingly, the Writ Appeal was allowed.

Cause Title: Life Insurance Corporation of India V. Hatripreetha T (Neutral Citation: 2025:KER:72989)

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