Court Sides with Beneficiary in Life Insurance Claim Dispute.
05 June 2024
Consumer Protection Act >> Consumer Rights | Insurance >> Personal Law
An insurance company's attempt to overturn a consumer commission's decision to award a life insurance payout has been unsuccessful. The State Consumer Disputes Redressal Commission had directed the company to pay the claim amount (sum assured) to the son of the deceased policyholder (Respondent). The insurance company (Appellant) appealed this decision, arguing the policyholder failed to disclose pre-existing medical conditions.
The crux of the case involved the non-disclosure of alleged medical conditions by the deceased (DLI) in the insurance application. The DLI passed away shortly after taking out the policy, prompting a claim from the son (Respondent). The insurance company denied the claim based on suspicion of undisclosed diabetes and paralysis.
The State Commission sided with the Respondent, finding the insurance company's evidence unconvincing. The Appellant argued an investigation revealed the DLI's treatment for these conditions and cited legal grounds for claim rejection due to non-disclosure. However, the court ultimately agreed with the State Commission's assessment of the evidence.
The court pointed out weaknesses in the Appellant's case. Statements from neighbors and a technician regarding the DLI's health were deemed unreliable. Additionally, the fact that the insurance company's own medical examiner certified the DLI's health cast doubt on the paralysis claim.