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RAJASTHAN STATE CONSUMER DISPUTES REDRESSAL COMMISSION, JAIPUR
ASHOK PARIHAR, SUNITA RANKA, JJ.
Maya Devi – Appellant
Versus
Life Insurance Corporation of India – Respondent
First Appeal No. 1098 of 2012
Decided On : 16-07-2013
Advocate Appeared:
For the Appellant : Mr. S.P. Gandhi.
For the Respondent: Mr. R.K. Soni.
Rejection of an insurance claim based on irrelevant grounds is unjustified if the cause of death is covered under the insurance policies.
Headnote:
Insurance Claim - Rejection of Claim - Suicide - Previous Illness and Treatment - Irrelevant Ground for Rejection
Fact of the Case:
The appellant's son had two insurance policies and died due to suicide. The insurance claim was rejected by the respondent on the ground of previous illness and treatment taken by the insured before taking the policies.
Finding of the Court:
The court found that the rejection of the claim based on the insured's previous illness and treatment was irrelevant and unjustified, as the death due to suicide was covered under the policies. The court allowed the appeal, set aside the impugned order, and directed the respondent to pay the insurance amount with interest and additional compensation to the appellant.
Issues: Rejection of insurance claim based on previous illness and treatment, coverage of death due to suicide under the policies
Ratio Decidendi: The ground for rejection of the claim was deemed irrelevant and unjustified, as the death due to suicide was covered under the insurance policies.
Final Decision: The appeal was allowed, the impugned order was set aside, and the respondent was directed to pay the insurance amount with interest and additional compensation to the appellant.
ORDER :
1. The appeal is directed against order dated 30.7.2012 passed by the District Forum Ajmer by which the complaint in regard to rejection of insurance claim has been dismissed by the District Forum.
2. As has come on record the son of the appellant took two insurance policies of Rs.1 lakh each on 08.08.2007 from the respondent while he was working as Constable in Rajasthan Police. The regular premium had also been deducted from the salary of the insured. However, unfortunately for the reasons not known, the insured died due to suicide on 14.4.2010. The insurance claim made by the appellant was repudiated by the respondent vide letter dated 25.3.2011 only on the ground that before taking the policies the insured had taken treatment in S.M.S. Hospital, Jaipur in the year 2006 as also in the year 2007.
3. After hearing the counsel for the parties, we have carefully gone through the material on record.
4. There is no dispute that the policies were issued in August 2007 and the death took place after more than two years due to suicide on 14.4.2010. Admittedly the death due to suicide is covered under the policies. Even if the insured had taken some treatment much prior to taking the insurance policies that could have been a ground for cancellation of the insurance policies. However, the insurance policies having duly been issued by the respondent and the death having taken place much after not due to any illness for which the treatment alleged to have been taken by the insured prior to issuing the insurance policies, the ground taken by the Insurance Company for rejection of the claim is wholly irrelevant and unjustified. Moreso and admittedly the death due to suicide is covered under the insurance policies. Under the circumstances the respondent as also the District Forum is not justified in rejecting the claim of the appellant only on the ground of concealment and misrepresentation in regard to previous illness and treatment taken.
5. Accordingly, the appeal is allowed. The impugned order dated 30.7.2012 passed by the District Forum is set aside. Consequently the complaint filed by the appellant before the District Forum is allowed and the respondent is directed to pay the insurance amount of Rs. 2 lakh to the appellant with 9% interest from the date of filing of the complaint i.e. 22.7.2011. In the facts and circumstances the respondent is further directed to pay a sum of Rs. 20,000/- (twenty thousand) as mental agony and other expenses to the appellant. The compliance of the directions issued above may now be made within thirty days.
