11 June 2024 Insurance >> Personal Law  

In a recent case, the High Court ruled in favor of a family whose deceased husband had an accidental insurance policy. The insurance company had denied the claim, citing a violation of policy terms. However, the court found in favor of the family due to the insurer's failure to meet its burden of proof.

Dalbeer Dhankar was insured under a Group Personal Accident Policy with an insurance company. The premium amount was deducted from his bank account. Sadly, Dalbeer died due to an electric shock while allegedly tampering with an electric pole. His family filed a claim for Rs. 5,00,000/- under the insurance policy.

The insurance company rejected the claim, arguing that the deceased's actions violated the policy terms. This denial led the family to challenge the decision in the courts.

The initial court case presented conflicting views. The District Forum sided with the insurance company, dismissing the complaint due to the deceased's actions. However, the State Commission overturned this decision and ruled in favor of the family, directing the insurance company to pay the claim amount with interest.

The State Commission's decision hinged on the insurance company's inability to provide the specific policy terms supposedly violated by the deceased. The court emphasized that the burden of proof lies with the insurer to demonstrate that the exclusion clause applies. Since the insurance company couldn't produce the relevant policy terms, the court couldn't uphold the denial of the claim.

The High Court upheld the State Commission's order, dismissing the insurance company's appeal. The court's decision reaffirmed the principle that the insurance company bears the responsibility of proving the applicability of an exclusion clause in a policy. Additionally, the court highlighted that exclusion clauses cannot be used to undermine the main purpose of the insurance policy itself.