Consumer forum asked National Insurance to pay 6 lac to a nominee

The South Mumbai District Consumer Disputes Redressal Forum has held that when the terms of an insurance policy are vague, benefits should be given to the insured. The insurer National Insurance Company denied the accidental death claim of a Mumbai resident on the ground that the death of his father, a senior citizen and a doctor, due to a fall at home, was not accidental and was caused by disease-related giddiness.

In its decision, the consumer forum told the insurer to pay the victim's son, Dr Sunil Vakil, the insured sum of Rs 5 lac along with an interest of Rs 1.20 lac. The forum also asked insurer to pay Rs 23,000 as compensation for an unfair trade practice and towards the costs of the complaint.

The forum cited a national commission order which said it was an accidental death even if an insured person suffered a fit and drowned or fell in front of a train and was killed.

The national commission ruling said “It is settled law that when two reasonable interpretations of the terms of the policy are possible, the interpretation which favours the insured is to be accepted and not the interpretation which favours the insurance. Further, the terms of the insurance policy are drafted one-sided by the insurance company. Therefore, in case the terms of the policy are vague, benefits should be given to the insured and not to the insurer."

Death, which does not occur in the usual course or natural course of events or causes which could not be reasonably anticipated, is considered accidental, the commission order added.

The insured Dr. ShirishVakil was covered under the Janata Personal Accident Insurance Policy.

Source: http://www.insuringindia.com/