General Insurance Company takes more than two years, from date of preferring claim.

Facts

Sukhwinder Singh had availed Accident Claim Policy. Sukhwinder met with an accident. He sustained injuries and after remaining indifferent hospitals died after 19 months.
Deceased lodged a claim immediately after accident. Insurance Company, one after another, appointed two separate Surveyors (Doctors at that) who visited the deceased at his residence. Whole of record is replete with details of injuries / fracture. Insurance Company is harping on the point that cause of death was jaundice and not the accident, but where is the proof. There is no death certificate giving the cause of death on record for Consumer Fora to examine the point. Insurance Company takes more than two years from date of preferring claim, and nine months from date of death, to repudiate claim.

Case of Insurance Company

Insurance Company repudiates claim on the ground that deceased, while taking policy, had concealed material facts relating to health that he had or was suffering from jaundice.
He was an alcoholic and had severe liver problem. He died on account of this ailment and not on account of accident. Sukhwinder was alcoholic and it was after such a bout that he was hit on the road. He had jaundice for a long time and be concealed this fact at the time of taking the policy.

Case of Widow Smt. Shavinder Kaur.

Both the Surveyors who visited deceased at his residence saw him in plaster-bed ridden; as a result of accident. He did not conceal any information at time of taking policy. Insurance Co. is unnecessarily trying to harass widow.

District Forum

Dismissed the complaint.

State Commission

State Commission allowed appeal of Shavinder Kaur.

Insurance Company and Shavinder, Both, Approach National Commission

Insurance Company prays setting aside order of State Commission. Shavinder throws counter-blast and prays for enhancement of compensation from Rs. 1 lakh directed by State Commission.

Observations of National Commission

No material on record to show that deceased had jaundice at time of taking policy; and, second, that this fact was within his knowledge. In order to lean on fact of concealment, Insurance Company has to prove its knowledge.

In any case, it was not a life policy but Accident Claim Policy.

Long delay of 2 years from date of accident and 9 months from date of death, to repudiate claim itself is a clear case of deficiency in service.

No interference in order of State Commission for payment of Rs. 1 Lakh, the insurance amount, with interest @ 12% effective from about 5 months from date of accident and costs of Rs. 2,000 awarded by State Commission. No revisions dismissed.

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