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Insurer rejects man's claim after dad's death, fined

An insurance company will have to pay nearly Rs 3 lakh as compensation to a Vidyavihar resident after it wrongly rejected his father's life insurance claim on the grounds that the latter had concealed a pre-existing disease while taking the policy in 2007.

Observing that the onus was on the insurance company to prove that there was material concealment of a disease which directly proved to be fatal, the South Mumbai District Consumer Disputes Redressal Forum also told Aviva Life Insurance to pay the heir of the deceased the insured amount of Rs 10.67 lakh. The forum held that the deceased, Balakrishan Makwana, was over 45 years old when he had obtained the policy and a mandatory medical check-up should have been conducted.

Balakrishan had subscribed to a policy plan called "Save Guard", under which he was to pay an annual premium of Rs 3 lakh and was promised an assured amount of Rs 15 lakh.

After paying two premiums, Balakrishna requested the company in January 2009 to convert the annual premium into a monthly premium as he was unable to pay Rs 3 lakh. The company accepted the request.

On April 28, 2009, Balakrishna complained of uneasiness while climbing the stairs and fell down. He was rushed to hospital, where he was declared dead. He had suffered a heart attack.

In May 2009, Balakrishna's son Hemal informed the insurance company officer about his father's death. On May 11, 2009, he received a sympathy letter and a death claim form from the company. Hemal submitted the required documents and filed the claim.

A few days later, he received a repudiation letter from the company stating that Balakrishanhad answered no to a specific question on diabetes and hypertension in the proposal form. Hemal filed a complaint in the consumer forum on August 30, 2010. The forum passed an ex parte order. Hemal told the forum that the company, in 2010, offered him part payment of Rs 4 lakh, which he accepted under protest.

Article referred:http://articles.timesofindia.indiatimes.com/2013-06-24/mumbai/40165265_1_4-lakh-3-lakh-hemal

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