Monday, January 13, 2014

LIC to pay Rs 3.71 lac as interest to man for repudiating claim

Insurance behemoth the Life Insurance Corporation (LIC) of India has been directed by a district consumer forum to pay a sum of Rs 3.71 lac towards interest along with the insurance amount of Rs 5.30 lac to one Mr. Kiran Patel, a resident of Ghatkopar, after the insurer wrongly repudiated his deceased father's insurance claim on the ground that his death from a staircase fall was not an accident but was caused by pre-existing hypertension.

The forum observed that that by not granting the double accident benefit, LIC had indulged in deficiency of service. The forum took the note of a neighbor's eyewitness account along with the medical papers to conclude, “We have no hesitation to conclude that the evidence brought on record by the complainant is sufficient to conclude that the deceased died due to the fall, which is sufficient to conclude due to accidental death and therefore the complainant fulfils the parameter for getting double accident benefit.“

The forum also cited an order of the National Commission, which says that even the murder of a person and his/her death due to murder is an accidental death.

The complainant, Mr. Patel argued that his father fell while climbing the staircase at their residential building and sustained severe head injuries on July 6, 2005. He underwent surgery for a hematoma sustained in the accident. But his health deteriorated and he died after suffering a cardiac arrest on July 10, 2005.

Despite submitting all documents along with claim, the insurer only granted the basic amount to the complainant. The insurer repudiated the double accident benefit claim. Thereafter, aggrieved Patel moved to the Additional Mumbai Suburban District Consumer Disputes Redressal Forum in February 2008.

The forum pointed out that from the examining of medical papers, it is seen that the deceased had subdural hematoma, which cannot be ruled out due to the fall.

“Secondly, the death certificate does not show anywhere the subdural hematoma sustained by Devji was not because of hypertension, nor does it show that the deceased Devji sustained a blood clot due to hypertension. On the contrary, the death certificate shows he died due to a cardiac arrest,“ the forum observed.

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