Insurance

For rejecting claim, insurance firm directed to pay Rs. 15 lakh

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The District Consumer Redressal Forum, Hyderabad-lll, on July 25 directed Birla Sun Life Insurance Company Limited to pay a policy amount of Rs. 15 lakh from date of claim till realisation, along with a compensation of Rs. 2 lakh for rejecting the claim “without unjust and valid reasons”.

The ruling was in favour of complainant N. Sangeetha, a resident of Ranga Reddy district, who approached the forum stating that Birla Sun Life Insurance Company Limited had rejected a policy claim of Rs. 15 lakh. She wrote that her late husband M.V. Lakshmi Ramana had taken the said policy on March 31, 2012, for a period of 30 years, and had paid the premium of Rs. 6,651 as well after taking it.

However, about a month after taking the policy, Mr. Ramana fell sick, and suffered from fever and vomiting, after which he was admitted at K.V.R Hospital in Kurnool district. After shifting him to another hospital in Hyderabad due to lack of expert doctors, the deceased was finally admitted at Care Hospital for better treatment. He remained there from April 28 to May 6 in 2012, wrote his wife to the forum.

Ms. Sangeetha stated that while undergoing treatment at Care Hospital, her husband passed away on May 6, 2012, due to swine flu. In spite of being notified, the insurance company did not respond and she then approached the insurance ombudsman. She wrote that her claim was rejected there too as the company had filed a false counter and even produced false certificates stating that her husband was suffering with serious diseases from the last 10 years.

Responding to Ms. Sangeetha’s petition, the insurance company stated that it had not adopted any unfair trade practice. It said that the complainant had suppressed facts and that Mr. Ramana was suffering from haemoptysis from the last 10 years, and had a history of malaria as well. The company wrote that it had collected medical records of the deceased from a hospital in Kothapet, Hyderabad.

Scrutinising the evidence at hand, the forum, however, ruled that the medical records provided by the insurance company were not enough to say that Mr. Ramana was suffering from illnesses before taking the policy. Further, the forum stated that he had died because of swine flu. Maintaining that the insurance claim’s rejection was “unjust”, it directed the company to pay Ms. Sangeetha Rs. 15 lakh, with 9 per cent interest per annum from date of claim till realisation, along with a compensation of Rs. 2 lakh.

The Hindu

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