Hemant Patel, a real-estate broker, lived in Delhi with his wife and two children. He owned a bungalow in Karol Bagh which was insured with Elite Insurance Company, New Delhi, for ₹ 35 lakh. On December 31st 2024, Hemant
CS Professional · Banking and Insurance - Laws and Practice · PYQS · June 2025
Hemant Patel, a real-estate broker, lived in Delhi with his wife and two children. He owned a bungalow in Karol Bagh which was insured with Elite Insurance Company, New Delhi, for ₹ 35 lakh. On December 31st 2024, Hemant went to the local club with his family to attend a New Year party. When they returned home in the early hours of the next day, they found that their house was burgled and many valuables were taken away. While the police investigation was going on, the insurer sent his surveyor to look into the cause of the loss, the compliance of the insured with the terms of the policy, and the amount of loss suffered by the policyholder. During the course of investigation, the surveyor observed significant discrepancies in the statements given by the insured. These discrepancies pertained to the list of items reported to have been stolen and the mismatch between the true value of these items and the amount supposedly involved in the burglary. When the surveyor submitted his report to the insurance company, he mentioned that the financial condition of the insured was not good before the burglary and he had increased the insurance coverage on his house just a few days before the burglary took place. Hemant's claim form was therefore rejected by the insurance company on the grounds of fraud. Hemant filed a lawsuit against the insurance company. Was Hemant eligible to receive the claim amount for the reported loss that he had suffered ?
Answer & Explanation:
No, Hemant was not eligible to receive the claim amount for the reported loss that he had suffered. The principle of 'utmost good faith' ( uberrimae fidei ) is fundamental to all insurance contracts. This principle requires both the insured and the insurer to disclose all material facts truthfully. Any breach of this principle, such as misrepresentation or non-disclosure of material facts, can render the contract voidable at the option of the innocent party. In this case, the surveyor's investigation revealed several red flags: Significant discrepancies: Hemant's statements regarding the list of stolen items and their true value showed significant mismatches. This suggests an attempt to inflate the claim amount. Financial motive: The surveyor noted that Hemant's financial condition was not good before the burglary, and he had increased his insurance coverage just days before the incident. This raises suspicion of a potential motive for fraud. These findings strongly indicate that Hemant acted fraudulently by either misrepresenting the facts of the loss or intentionally causing/exaggerating the loss for financial gain. Insurance is designed to indemnify for actual losses due to unforeseen events, not to provide a means for financial enrichment through deceit. Therefore, based on the evidence of discrepancies and potential fraudulent intent, the insurance company was justified in rejecting Hemant's claim on the grounds of fraud. Hemant's eligibility for the claim is negated by his breach of utmost good faith and the fraudulent nature of the claim.
Topics: Insurance Claims
Related Questions in this Topic
- An industry that is insured for ₹ 1,000 Crores with a Premium of ₹ 50 Crores, that is shared by A, B and C Insurance Com...
- Hemant Patel, a real-estate broker, lived in Delhi with his wife and two children. He owned a bungalow in Karol Bagh whi...
- Three friends, Mr. Ashok, Mr. Lalit, and Mr. Hari-teamed up to start a lobster export business. Mr. Ashok owned a boat w...
- Three friends, Mr. Ashok, Mr. Lalit, and Mr. Hari-teamed up to start a lobster export business. Mr. Ashok owned a boat w...
- X purchased a Life Insurance Policy on 3rd day of March 2024. He had declared in the Proposal Form that he was suffering...