Insurance firm asked to pay Rs 3 lakh claim to widow

A consumer court here has directed an insurance company to pay Rs 3 lakh claim amount to a woman following the death of her husband due to illness.
In her complaint, the woman Mamta Prakash Gandhi informed the Thane District Consumer Redressel Forum that her late husband Prakash Gandhi had taken two policies from Bajaj Allianz Life Insurance Company of total Rs 3 lakhs in 2006.
During his treatment at a hospital here, he died on October 19, 2008, and hence she lodged a claim for Rs 3 lakhs with the insurer.
The insurance firm rejected the claim saying that the deceased had liver cirrhosis since seven years prior to his death and he had hidden the same from the company while taking the insurance in 2006, hence the claim should be rejected.

The deceased's family doctor issued a certificate in October 2008 after Gandhi's death, stating that the deceased suffered from diabetes from February 2008 and liver cirrhosis from March 2008.
However, the insurance company submitted an investigating report by Onicra Credit Rating Agency of India Ltd which the forum refused to accept, saying that it was not accompanied by an affidavit.

Also, the insurer stood on its argument that the deceased had the disease for seven years before his death and that its statement was based on the certificates issued by the family doctor of the deceased.
However, forum president Sneha Mhatre and members Madhuri Vishwarupe and N D Kadam refused to accept the rejoinder along with the certificate, purported to have been issued by family doctor of the deceased, as it was neither on his letter head nor on the letter of the Jupiter Hospital.

Also there was no affidavit along with it, the forum noted.
It also observed that the insurance company had not submitted certificate from any doctor other than the family doctor of the deceased, which also defeats the argument put forth by the insurer.
Hence taking into account all the circumstances and documents produced before it, the forum ordered that the insurer was deficient in its services and needs to honour the death claim of Rs 3 lakh by the complainant.
It, therefore, asked the insurance firm to pay the claim amount to the widow along with Rs 35,000 towards legal expenses and compensation for mental agony to the woman.