LIC asked to pay for denying claim arbitrarily

A consumer forum has directed the Life Insurance Corporation to pay  Rs one lakh to the husband of a policy holder for ‘arbitrarily’ rejecting his claim for the assured amount on his wife’s death.

The New Delhi District Consumer Disputes Redressal Forum observed that LIC had ‘misdirected itself’ by not showing any evidence that the deceased was suffering from asthma prior to availing the policy and had not ‘applied its mind’ while denying his claim. The LIC had denied the claim saying the woman was an asthma patient and had not disclosed her illness while taking the policy.

It had relied on a discharge summary of 2004 to reject the claim.

“We have considered the material on record and submission made. It is patent that opposite party (LIC) has misdirected itself. It has not brought any evidence of deceased suffering from asthma before taking of policy in 2003 or any record of taking treatment.

“The discharge summary of 2004 is of no use. It shows trouble for 4-5 days in 2004 and not before taking policy in 2003. Opposite party has not applied its mind. We hold it guilty of deficiency in service by arbitrarily repudiating the claim,” according to the bench presided by C.K. Chaturvedi.

It directed LIC to pay the sum insured of Rs 50,000 along with ‘punitive damages’ of Rs 50,000 to Delhi resident Dev Raj whose wife had died in December 2005. The forum also directed LIC to obtain half of the damages from salary of the officer concerned ‘who gave no attention to the appeal and agreed for repudiating the claim’.

Raj, in his complaint, had said that his wife had obtained the policy for Rs 50,000 from LIC in 2003 and under it she was covered till 2005, but the insurance firm had rejected his claim on the ground that she was an asthma patient.

Consumer Court: Death due to doctor’s negligent act is an accident

Doctor’s rash or negligent act resulting in death amounts to an accident apex consumer panel has held while making the victim entitled to the accidental death benefits from his or her insurer.

 The National Consumer Disputes Redressal Forum (NCDRC) gave the ruling while ordering the Life Insurance Corporation (LIC) of India to pay the accidental death benefits to the husband of the insured, who had died while being operated upon.

 “The life assured (the insured) died during an operation by the treating doctors. Thus, the injury to the life assured was an accident caused by outward, violent and visible means and therefore, the Life Insurance Corporation of India cannot be absolved from its liability to pay the accidental benefits to the complainant,” the NCDRC said.

 The LIC had denied the accidental benefits to Haryana resident Narender Singh, the husband of the insured, saying his wife’s death during the surgery was not an accident.

 It had also contended that the doctors were not negligent or rash as they had performed the surgery fairly without any ill-intention or mens rea.

 The bench presided by Justice J M Malik rejected the contentions as “devoid of force” and pointed out that “a criminal case under section 304-A (of Indian Penal Code) is pending against the doctors. A criminal case crops up by a negligent and rash act. Mens rea is not required.” It also observed “the negligence and rashness” as well as deficiency of service of the doctors was evident from the fact that no anaesthetist was present during the surgery.

 “Without calling the anaesthetist, the doctors should not have treated the patient at all. This itself speaks deficiency in service on the part of the doctors as well as negligence and rashness,” the NCDRC said