A consumer commission in Haryana has mandated a private life insurance provider to compensate a man with Rs 5 lakh following the rejection of his claim related to his mother’s death. The insurer had denied the claim, allegedly citing a pre-existing medical condition, but the commission deemed this refusal unlawful due to the lack of any supporting medical documentation from the company.
The Panipat District Consumer Disputes Redressal Commission, led by President R K Dogra along with members Rekha Chaudhar and Vineet Kaushik, also ordered an additional Rs 11,000 for the distress and harassment caused, along with Rs 5,500 to cover legal expenses.
In a statement issued on September 14, the commission noted, “The argument presented in the insurer’s written response merely claims that the complainant is ineligible because his mother denied having any prior illness in the declaration form when the insurance policy was obtained. However, the respondents have not provided any documentation to substantiate their assertion of a pre-existing condition at the time the policy was issued.”
The commission further asserted that the insurer’s claims—that the complaint was not valid or based on concealed information—were rendered irrelevant due to their failure to present any evidence supporting their allegations.
The complainant’s mother reportedly passed away from natural causes on May 15, 2019. Acting as her nominee, he submitted the required death certificate and other documents to claim the insured amount.
The insurance company initially rejected the claim, alleging that the deceased had concealed existing medical issues and misrepresented her health status in the application.
After sending an unresolved legal notice, the complainant approached the consumer commission seeking the claim amount along with interest and compensation for the mental distress caused, as well as legal costs.
The insurer contended that the deceased had misrepresented her health condition and failed to disclose significant medical facts while completing the proposal form, arguing that this non-disclosure invalidated the insurance contract.
Since the policy was acquired online through a digital credit marketplace acting as the master policyholder for the insurance company’s term plan, the company claimed it was the master policyholder’s responsibility to ensure that all information in the Member Information Form (MIF) was accurate and complete.
The commission’s ruling emphasized that the complainant demonstrated that the policy was legitimately issued by the respondents, who had also accepted a premium payment of Rs 4,755. According to the policy’s terms, the complainant, as the nominee, is entitled to the insured benefit due to his deceased mother.
Moreover, the commission pointed out that despite the insurer’s claims of the deceased’s concealment of health issues, they failed to provide any medical documentation or evidence indicating she had any ailments prior to acquiring the policy.
This judgment highlighted that insurance companies cannot deny claims solely based on allegations of undisclosed pre-existing conditions without providing supporting evidence. The ruling reinforces the necessity of accountability in insurance claims and safeguards nominees against unwarranted denial of valid policies.
Consumers experiencing similar issues are encouraged to reach out to their state’s consumer helpline (Haryana: 1800-180-2087) or contact the National Consumer Helpline at 1915 for assistance.
In related news, a Haryana resident successfully claimed Rs 6,800 after a toll plaza overcharged him and refused to issue a refund. Additionally, a woman was awarded Rs 86,200 by a wellness clinic after attending only four out of ten weight loss sessions, and another man won Rs 1 lakh due to a holiday company’s refusal to honor a hotel booking and subsequent delays in refunding his membership.
Jagriti Rai contributes to The Indian Express (Digital), reporting at the crucial intersection of law, gender, and societal issues. Operating within a dedicated legal desk, she specializes in translating intricate legal frameworks into accessible narratives, examining the impacts of judicial and legislative changes on citizens’ daily lives.
Her expertise includes a socio-legal focus that critically addresses contemporary social issues, particularly regarding gender rights and marginalized communities. With over four years of experience in both digital and mainstream media, she has cultivated a versatile reporting style, having worked with prominent platforms like The Lallantop and Dainik Bhaskar.
Jagriti holds a Post-Graduate degree in Journalism from the Indian Institute of Mass Communication (IIMC), India’s leading media training institution, as well as a Master of Arts in Ancient History from Banaras Hindu University (BHU), which equips her with the historical and cultural insights necessary for analyzing enduring social structures and legal developments.
