New Delhi, Nov 3
A home loan applicant's widow's mother has got relief from the National Consumer Commission that has directed his life insurer to pay over Rs 14 lakh cover, setting aside the company's claim that the Chhattisgarh resident died due to ailments not covered under the policy.
After Ashok Patel's death, his mother, Rupkuwar Patel, dragged HDFC Ergo General Insurance to consumer court in 2018 after it failed to pay the insurance claim to settle the home loan. The district forum and the State Consumer Commission held the company guilty of deficiency in service and directed it to pay up. The Apex Consumer Court has now upheld the findings of the two lower courts, which determined that the denial of a death insurance claim to Patel's mother was a deficiency in service. Inderjit Singh, presiding member of the NCDRC, stated in the verdict: "After giving thoughtful consideration to the entire facts and circumstances of the case, various pleas raised by the parties, we find that there is no illegality or material irregularity or jurisdictional error in the order of the State Commission; hence, the same is upheld. Accordingly, the Revision Petition by HDFC Ergo General Insurance is dismissed." Following the NCDRC's recent ruling, the insurance company has the option of challenging the decision in the Supreme Court. Two months after Patel died in September 2017, his mother was informed that her son's insurance claim had been repudiated on the grounds that his death was due to Acute Respiratory Distress Syndrome (ARDS), Acute Respiratory Failure, and Sickle Cell Crisis. These ailments were not covered under the insurance policy. The insurance company argued in its appeal before the National Consumer Commission that "the State Commission failed to appreciate the settled law that the onus is on the insured to prove that the claim falls under the purview of the policy." According to the Claim Forum, Ashok Patel's mother had lodged a claim for 'stroke' but failed to establish that he had suffered or died due to a stroke. Therefore, they contended that the impugned order should be set aside on this sole ground. The NCDRC endorsed the State Commission's decision, upholding that Rupkuwar Patel was the nominee of the deceased and thus had the right to file a claim. The State Commission noted that the insurance company did not produce any documents to ascertain that Ashok Kumar Patel had provided any incorrect information in the proposal form of the policy. "Therefore, the arguments of the company are not acceptable in the absence of any documentary evidence to support them. They cannot be accepted on the basis of mere pleadings; hence, the concerned forum has not committed any error by accepting the complaint. Therefore, the appeal should be dismissed and the order passed should be confirmed," stated the State Commission, agreeing with the findings of the district forum.