LIC to pay compensation to widow for wrongly rejecting husband's insurance claim

The Maharashtra State Consumer Disputes Redressal Commission has governed the Life Insurance Corporation of India (LIC) to pay a compensation of Rs 1 lac with 9% interest from March’ 2000 to a widow for wrongly rejecting her husband’s insurance claim. This verdict came after the country’s largest insurance company had filed an appeal in the state commission in 2003 against the decision of a district forum, who ruled in favour of the widow.

On July 2, 1997, Pradeep, a resident of Vile Parle in Maharashtra suffered a heart attack and died. His widow, Asha Dave submitted the claim form to the insurer, but the insurer rejected her claim on the grounds that her husband Pradeep had suppressed that he was suffering from hypertension. Then, the widow, Asha Dave moved to district consumer forum in year 2001. The forum ruled in favour of Asha. After that, the state-run insurer filed an appeal in the Maharashtra State Consumer Disputes Redressal Commission.

In its appeal, the LIC claimed that the insured’s certificate of treatment/consultation signed by his doctor revealed that he suffered from hypertension.
The commission said, “We find no reason to believe that the deceased had suppressed any material fact of suffering from hypertension.”

“It cannot be said that the LIC had a valid reason to repudiate the claim. Repudiation being arbitrary, deficiency in service on the part of LIC is well established, the commission added.
Asha rejected LIC’s claim that her husband was suffering from hypertension. She said when the LIC recorded details for Pradeep’s health statement in 1997; he was not suffering from hypertension. A mediclaim attendant's certificate issued after Pradeep's death to Asha by the same doctor who had signed his certificate of treatment/consultation stated that he did not suffer from hypertension. "This declaration assumes more weightage," the commission said. "The certificate of treatment/consultation cannot be believed."

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