Can
Insurers deny a death claim because of
non-production of FIR and post-mortem
? - No says the Consumer Disputes Redressal
Forum, Ahmedabad (Rural).
In
the impugned case a person was insured for Rs. 1 lakh under a Group Insurance
scheme of Coop Credit Society at Mehsana – the Insurers being UIIC. One amongst the group reportedly suffered a
severe head injury at his residence in Feb 2008 and was admitted in a locally
well known hospital in Ahmedabad. He did
not respond positively to the treatment and unfortunately died at the
hospital the next day. The wife of the
deceased preferred a claim on the Insurers submitting all documents.
The
Insurers repudiated the claim on the ground that neither a
first information report (FIR) nor a post-mortem examination report had
been submitted. The company treated the claim as rejected and closed. The wife of the deceased along with
Consumer Education & Research
Society filed a complaint with the Forum
against the Insurers accusing them of deficiency in service and claiming Rs.
1,00,000 with 12 per cent interest from 19 February
2008, Rs. 5,000 for her mental agony and harassment, and Rs. 2,000 towards
cost.
It
was contended by the plaintiff that the attending Doctor had clearly stated that
as the medical findings were sufficient for diagnosis and ascertaining the
cause of death, the hospital authorities had not proceeded with a post-mortem
examination. The Insurers however
contended that ‘a post-mortem note’ is required after a death involving an
accident insurance claim. The complainants had not fulfilled this condition and
such a claim cannot be sanctioned on the basis of Dr. certificate and that the
Insurer was not bound to accept such a certificate. Citing several precedents,
the complainants stated that when a person dies following a serious injury
suffered at home, the case does not warrant an FIR, or a panchnama
or a post-mortem examination report.
The
Forum admitted the complaint and held the Insurers guilty of deficiency in service,
directing the company to pay the insurance amount with interest, compensation
for harassment and agony, and cost.
This
is a case filed by Cosumer Education and Research
Society (CERS) and Jyotsna Ambalal Patel and reported
by CERC in their communication.
With
regards – S. Sampathkumar
Insurance for the accomplished ancestors additionally requires that all the developed ancestors associates be absolutely acquainted of all the allowance behavior taken, their allowances and exclusions and area they are kept. Having an accessible altercation about continued appellation accumulation and allowance affairs both for the aliment earner and home maker and for accouchement body a more good ancestors compassionate and bond.
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