NCDRC Verdict: ₹3 Lakh Awarded to Widow in Insurance Claim Case Against LIC
In a significant decision, the National Consumer Disputes Redressal Commission (NCDRC) has ordered the Life Insurance Corporation of India (LIC) to pay ₹3 lakh to the petitioner, Renu, widow of the insured, Mr. Surender Kumar. This ruling comes after a lengthy legal battle that began with the repudiation of the insurance claim.
Background of the Case
Mr. Surender Kumar had purchased an insurance policy, "New Jeevan Anand (with profits)," from LIC on March 19, 2014, with a sum assured of ₹3,00,000. Tragically, he was admitted to PGIMS, Rohtak, on May 25, 2014, for chest pain, abdominal pain, and myalgia, and he passed away on May 26, 2014. However, LIC denied the claim, citing that Mr. Surender Kumar had not disclosed his pre-existing chronic kidney disease.
Legal Proceedings
The dispute began when Renu, the widow, filed a complaint before the District Consumer Disputes Redressal Forum, Rohtak, in Consumer Complaint No. 460. The District Forum ruled in favor of the petitioner, ordering LIC to pay ₹3,00,000 along with interest at 9% per annum from October 6, 2015, until the actual realization, and an additional ₹5,000 as litigation expenses.
Dissatisfied with this decision, LIC appealed to the State Consumer Disputes Redressal Commission, Haryana, challenging the District Forum's order. The State Commission, in its order dated March 21, 2018, accepted LIC's appeal and dismissed the complaint.
Key Arguments
Renu contended that there was no evidence of previous treatment for Mr. Surender Kumar's ailment. She also cited the judgment in New India Assurance Co. Ltd. Vs. Rakesh Kumar (III 2014 CPJ 340), where the National Commission held that the insurance company failed to produce any evidence to prove the insured's pre-existing ailments.
LIC argued that Mr. Surender Kumar had concealed material facts related to his health when applying for the insurance policy. They claimed that he was suffering from chronic kidney disease and hypertensive nephropathy but did not disclose it in his proposal form.
NCDRC Verdict
After a thorough review of the case, the NCDRC found that there was no concrete evidence to establish that Mr. Surender Kumar had suppressed any pre-existing ailments or provided false answers regarding his health when purchasing the insurance policy. The Commission noted that the medical records presented did not conclusively demonstrate the insured's pre-existing conditions.
Consequently, the NCDRC set aside the State Commission's order and reinstated the District Forum's decision, directing LIC to pay ₹3,00,000 to the petitioner, Renu, as per the terms of the policy.
This ruling by the NCDRC serves as a landmark verdict in the realm of insurance claims and underscores the importance of thorough investigation and evidence presentation in such cases. It highlights that claimants should not be denied their rightful insurance benefits without substantial proof of non-disclosure or fraudulent intent.
Link to NCDRC Order: Click Here
Case Number: Revision Petition No. 1963 of 2018
Date of Filing: 06 October 2023
Jurisdiction: National Consumer Disputes Redressal Commission (NCDRC), New Delhi
Petitioner: Renu, widow of Surinder Kumar
Respondent: Life Insurance Corporation of India (LIC)
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