Mumbai: Rekha Ved, a widow has won an insurance claim of Rs 10 lakh along with an accumulated bonus that will have to be given to her with six percent interest from November 2018. Additionally, she is also directed to be given Rs 10,000 for harassment and Rs 5,000 towards litigation cost.
The order was given after Ved, a Ghatkopar resident had filed a case against Life Insurance Corporation (LIC). The order dated October 18, 2022 was passed by R. G. Wankhade, president and S V Kalal, member of additional Mumbai Suburban District Consumer Disputes Redressal Commission.
Ved had approached the Commission after her insurance claim was rejected by LIC. Her husband had taken two policies from LIC beginning from March 28, 2016 and April 15, 2016 with insurance cover of Rs 3 lakhs and Rs 7 lakhs respectively. He had paid the premiums regularly.
LIC rejects the claim
On August 15, 2018, her husband passed away. The Insurance firm rejected her claim stating her husband had given false information on the form filled by him if one has to take the medical reason for his demise.
LIC denied all allegations in the complaint and said that the claim was rejected because her husband died within three years of the policy. He died of heart related ailments and for the past 10 years he had high blood pressure as per the hospital reports submitted by the complainant for seeking the amount.
Ved vs LIC
Ved submitted before the Commission that her husband was 60 years at the time of taking the policy and a medical officer had checked him before issuing him the policies. She gave a copy of the same and also the form that her husband had filled in. The copies have the sign and seal of the medical officer and the hospital that had checked her husband.
In the form, it was mentioned that no question will be asked after two years from the date of policy. However, when the claim was made, it was well past two and a half years. The Commission observed that raising a question after two and a half years is violating the terms of the policy. It added that a medical check up was done despite the complainant crossing 60 years of age and in normal circumstances, post 40 years of age, some or the other medical issue comes up.
The Commission stated that the policies taken were of 'Jeevan Vima Policy', which is taken to keep one secured of dangers in life and is also the motive of such policies. Family members of the deceased are expected to get benefits once the insured person passes away in such a case and by rejecting the claim, the firm has made hole in the scheme. Hence they have indulged in unfair trade practice and upheld the complaint.
