"We have deprecated this practice of insurance companies of taking a flimsy clue or remote reference from the discharge summary or statement with a view to reject the rightful claim of the insured. It appears that this is how the respondent (LIC) has become one of the richest organisation in India," a bench presided by the commission's member Salma Noor said.
The commission made the observation while directing LIC to pay Rs 24.2 lakh, including the compensation and the sum assured, to the husband of a insurance policy holder who had died of infection after a surgery for removal of her uterus.
The bench, also comprising its member V K Gupta, said LIC should realise that it "survives and thrives" on consumer and "propensity to become unjustly rich by rejecting their claims" is highly depreciable.
The LIC had rejected Delhi resident Yogesh Baisiwala's claim on the ground that his wife had concealed the fact that she had been a heart patient at the time of availing the insurance cover.
The state-owned insurance firm relied on an angiography undergone by the woman, prior to her obtaining the policy, to contend she had been a heart patient.
The bench rejected the firm's contention and directed LIC to honour the claim saying the woman had died due to some infection, contracted subsequent to her surgery for uterus removal, and not of heart ailment.
It also pointed out that an angiography is a test for ascertaining whether a person is suffering from any heart ailment and it is not a disease or a pre-existing problem. (More)
