Wednesday, February 1, 2012

Accident Insurance - Insurer cannot deny even if there is no FIR / Post-mortem rules Consumer Forum


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

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