Calling an insurance company’s refusal to pay a monetary claim as an ‘unfair practice’, a Mumbai consumer redressal forum directed the company to pay a woman Rs 5 lakh with interest within a month. The woman, whose husband died of snake bite, was refused the insurance benefit on the ground that she failed to produce her husband’s post-mortem report.
The forum, however, observed that the New India Assurance Company should have taken note of the hospital’s report and sanctioned the claim on ‘humanitarian grounds’.
“Depending upon the circumstances and reports of the medical officer of ICON Hospital as well as the police department, the claim should have been sanctioned on humanitarian ground,” the forum observed.
Dombivali-resident Ashok Bhoir had availed of a ‘luxury membership’ of the Prabhadevi-based Pancards Club in 2007. One of the club’s schemes was benefit of insurance policies to its members, courtesy a tie-up with the insurance company.
The club got Bhoir two insurance policies with sum insured for Rs 5 lakh in one and Rs 25,000 in the other from the insurance company. The two policies, accidental death and mediclaim, commenced from May 18 and May 23, 2007, respectively.
On June 22, 2008, Bhoir, while giving fodder to his livestock, got bitten by a venomous snake. He was taken to a hospital, but succumbed to cardio-respiratory failure at 9.15 pm on the same day.
Subsequently, the hospital issued a death certificate and sent it to the local police station. The police, after carrying out an inquiry and drawing a panchnama, concluded that Bhoir’s was an accidental death.
Though the insurance company, on March 4, 2009, sanctioned Rs 19, 604 towards mediclaim, it refused the accidental death claim of Rs 5 lakh. The club too refused to help Bhoir’s wife with litigation and asked her to ‘take necessary steps’.
The insurance company, in its letter dated January 24, 2011, said, “The personal accident insurance policy can not be sanctioned as the post-mortem was not done.” Usha claimed that she was entitled to get the insurance sum and issued a legal notice to the club as well as the company on March 30, 2011.
Observing that the company action indicated unfair practice, the forum said, “There is no proof with the insurance company to show that there is any mischief or malafide intention of the complainant in demanding the claim.”
“The insurance company had received premium from the club and issued group medical insurance policies for the benefit of the members including her husband of the complainant.”
The forum directed New India Assurance to pay Rs 5 lakh with nine per cent interest from March 12, 2012 (date of filing of the complaint). They also slapped Rs 25,000 against the company for causing mental agony and litigation costs.