NCDRC directs Reliance Life Insurance to pay claim, interest & compensation to policyholder's widow

Apex consumer commission NCDRC has directed Reliance Life Insurance Company Limited to pay claim amount of Rs 10 lakh to a policyholder's widow, along with interest and compensation, saying that the company was "not justified in repudiating the claim".

The National Consumer Disputes Redressal Commission (NCDRC) has directed the insurance company to pay Telangana resident Marri Sujata the claim amount which was denied to her husband on the ground that the deceased had previously undergone treatment for the same disease.

The commission also granted compensation of Rs 10,000 to the woman, along with 7.5 per cent interest from August 1, 2012, the date of filing of the complaint.

"The petitioners (insurance company) were not justified in repudiating the claim. The district forum as also the state commission have rightly allowed the claim," said NCDRC President R K Agrawal and member M Shreesha, while upholding the state consumer forum's order.

Reliance Life Insurance Company Limited had filed a revision petition challenging the 2017 order passed by the Telangana State Consumer Disputes Redressal Commission, which had upheld the district forum's direction.

According to the complaint, the policyholder died in 2010 while undergoing treatment of carcinoma tongue, a type of cancer, for a period of six months.

He took treatment from two hospitals and died during the course of the treatment.

The claim of Sujata, the deceased's nominee, was repudiated by the insurance company in 2011, saying he had undergone treatment for carcinoma tongue for the past two years and, therefore, the claim was not maintainable.

The insurance company submitted a prescription issued by one Dr Prem Sharma of Prithvi Hospital, where the deceased was treated, saying he had undergone a surgery two years back.

However, the court noted that mere mention of the surgery in the prescription note of the doctor will not establish that the deceased had undergone treatment or that he was suffering from the disease for two years.

"Mere mention of 'hemimandilectomy done two years back' in the prescription of Dr. Prem Sharma, who was in the Prithvi Hospital, would not establish that the deceased was undergoing treatment and was suffering from that disease for two years," the commission noted.