Bajaj Allianz General Insurance Company Limited has been directed by the Consumer Forum to pay Rs 5,01,414 for an insurance policy to the legal heir of a deceased client,whose insurance claim they had refuted alleging that the deceased had furnished wrong information in the proposal form to get an insurance cover.
The deceased,Suman Verma,wife of complainant Ashwani Verma,took a Travel Care Policy from the insurance company in April 2011. She travelled to the US in August 2011 and died a natural death six days later. Her husbands claim on the insurance was denied by the company on the grounds of pre-existing disease which was not disclosed to the company.
The firm claimed that the documents submitted by the complainant,now,revealed that the deceased was a chronic patient of asthma,depression and hypothyroidism,including obesity. It further stated that the present ailment was caused due to pre-existing ailment that occurred before the policy inception date,leaving the company unaccountable to pay for the claim.
Despite the fact that the company claimed to have sent the insured a copy of the policys terms and conditions,it failed to prove on record that the same was received by the deceased. In the absence of which,it could not raise the plea that the claim had been repudiated by the insured.
The forum ruled that since she died a natural death,as per the autopsy protocol,there was no nexus between the cause of death and the alleged pre- existing ailments of the deceased.
The total claim by the complainants,to be paid by the insurance company,includes their traveling cost from USA to India and other expenses,and the company is,additionally,directed to compensate them with Rs 30,000 and pay litigation cost of Rs 15,000.