{"id":249811,"date":"2021-06-15T12:00:13","date_gmt":"2021-06-15T06:30:13","guid":{"rendered":"https:\/\/www.scconline.com\/blog\/?p=249811"},"modified":"2021-07-16T17:47:42","modified_gmt":"2021-07-16T12:17:42","slug":"death-insurance-claim","status":"publish","type":"post","link":"https:\/\/www.scconline.com\/blog\/post\/2021\/06\/15\/death-insurance-claim\/","title":{"rendered":"NCDRC | In a case of death insurance claim, can police investigation be replaced by private agency investigation engaged by insurance company? Commission spells out"},"content":{"rendered":"

National Consumer Disputes Redressal Commission (NCDRC): <\/strong>Dinesh Singh (Presiding Member) addresses matter regarding claiming of insurance cover.<\/p>\n

Instant appeal was filed under Section 19 of the Consumer Protection Act, 1986 challenging the decision of the State Consumer Disputes Redressal Commission.<\/p>\n

Factual Matrix<\/strong><\/p>\n

Late Jai Prakash, husband\/father of the Complainant met an unnatural death, had obtained four insurance policies from the Insurance Company. It was stated that the Insurance Company did not query three of the four policies.<\/p>\n

In respect of the 4th<\/sup> policy, it was objected that the claim was on the ground that the death was not accidental but a case of suicide, falling under the exceptions to the policy, and the claim was declined.<\/p>\n

Insurance Company argued that the three policies were concealed while taking the fourth policy i.e. the subject policy.<\/p>\n

Commission agreed with the appraisal and reasoning of the State Commission\u2019s findings that in the instant case non-disclosure of the previous policies by the life assured was not fatal to the claim.<\/p>\n

Another argument made by the Insurance Company was that the life assured had committed suicide which fell under the exception clause of the policy, that it was not a case of accidental death. Further, the insurance company reported that the injuries on the deceased were only possible in cases of a suicide death.<\/p>\n

Police in its Inquiry Report had concluded that the cause of the accident due to rail accident could not be ruled out.<\/p>\n

The insurance company had raised the objection of suicide based on the \u201cmedico-legal\u201d report of a private agency, prepared on perusal of the documents on record, after about one year of the incident.<\/p>\n

Inquest is conducted as mandated under the Cr.P.C., Post Mortem is conducted by the concerned government Medical Officer, Investigation is conducted by the Police (a private agency engaged by the Insurance Co. does not substitute for the Police).<\/em><\/p>\n

\u00a0<\/em>It was further noted that there was no evidence on record that the Insurance Company made a police complaint or filed a complaint before the competent judicial magistrate that a false case of accidental death had been made out for a wrongful gain when the death was by suicide, or that any remedial action in case of the other three policies settled earlier was subsequently undertaken, or any disciplinary action against its functionaries responsible for settling the earlier three policies was taken.<\/p>\n

Commission stated that weighing the evidence in its totality, the eventuality of the death being accidental cannot be ruled out and the benefit of preponderance of probability goes to the complainants.<\/p>\n

Hence, State Commission erred in placing reliance on the report of a private agency engaged by the Insurance Company while ignoring the complete spectrum of evidence in the matter.<\/p>\n

Therefore, the Insurance Company wrongly withheld the claim in respect of the subject policy.<\/p>\n

Bench directed the Insurance Company to settle the claim of the subject policy with interest at 9% per annum.<\/p>\n

For the undue harassment and the loss and injury caused to the Complainants and for the inconsistency and arbitrariness in decision making, a cost of Rs. 1 lakh is imposed on the Insurance Co. through its chief executive, of which Rs. 50 thousand shall be paid to the Complainants and Rs. 50 thousand shall be deposited in the Consumer Legal Aid Account of the State Commission.<\/p>\n

\u201c\u2026advised to inculcate and imbibe systemic improvements for future, in that there is no inconsistency or arbitrariness in decision-making in identical facts and same points of law.\u201d<\/em><\/p>\n

[Kamla Devi v. Tata AIG Life Insurance Corporation, 2021 SCC OnLine NCDRC 182<\/b><\/a>, decided on 10-06-2021]<\/p>\n

\n
\n
\n
\n

For the Appellant:\u00a0Mr. Praveen Kumar Aggarwal, Advocate<\/span><\/p>\n<\/div>\n

\n

For the Respondents No. 1 &2: Mr. S. Hari Haran, Advocate<\/p>\n<\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

National Consumer Disputes Redressal Commission (NCDRC): Dinesh Singh (Presiding Member) addresses matter regarding claiming of insurance cover. Instant appeal was filed under <\/p>\n","protected":false},"author":8808,"featured_media":199533,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[3,11],"tags":[31947,14601,25753,29785,3095,44477,46217,2752],"class_list":["post-249811","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-casebriefs","category-tribunals_commissions_regulatorybodies","tag-accidental-death","tag-consumer","tag-insurance-company","tag-law","tag-NCDRC","tag-police-investigation","tag-rail-accident","tag-Suicide"],"yoast_head":"\nNCDRC | In a case of death insurance claim, can police investigation be replaced by private agency investigation engaged by insurance company? 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Read Commission’s decision","author":"Bhumika Indulia","date":"December 15, 2020","format":false,"excerpt":"National Consumer Disputes Redressal Commission (NCDRC): Dinesh Singh (Presiding Member) while addressing the instant first appeal upheld the State Commission's Order in regard to a claim filed by the insured with the insurance company. The instant appeal was filed under Section 19 of the Consumer Protection Act, 1986 challenging the\u2026","rel":"","context":"In "Case Briefs"","block_context":{"text":"Case Briefs","link":"https:\/\/www.scconline.com\/blog\/post\/category\/casebriefs\/"},"img":{"alt_text":"National Consumer Disputes Redressal Commission","src":"https:\/\/i0.wp.com\/www.scconline.com\/blog\/wp-content\/uploads\/2018\/08\/NCDRC_.jpg?resize=350%2C200&ssl=1","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/www.scconline.com\/blog\/wp-content\/uploads\/2018\/08\/NCDRC_.jpg?resize=350%2C200&ssl=1 1x, https:\/\/i0.wp.com\/www.scconline.com\/blog\/wp-content\/uploads\/2018\/08\/NCDRC_.jpg?resize=525%2C300&ssl=1 1.5x, https:\/\/i0.wp.com\/www.scconline.com\/blog\/wp-content\/uploads\/2018\/08\/NCDRC_.jpg?resize=700%2C400&ssl=1 2x, https:\/\/i0.wp.com\/www.scconline.com\/blog\/wp-content\/uploads\/2018\/08\/NCDRC_.jpg?resize=1050%2C600&ssl=1 3x"},"classes":[]},{"id":253208,"url":"https:\/\/www.scconline.com\/blog\/post\/2021\/08\/25\/valuation-of-lost-gold\/","url_meta":{"origin":249811,"position":1},"title":"Opening Pandora’s Box | Whether valuation of lost gold can be determined as on date when reimbursement is made by insurer? NCDRC determines","author":"Bhumika Indulia","date":"August 25, 2021","format":false,"excerpt":"National Consumer Disputes Redressal Commission (NCDRC): C. Viswanath (Presiding Member) while addressing the appeal, expressed that: If the valuation of the lost gold is determined as on the date when reimbursement is made by insurer, it would open Pandora\u2019s box where the beneficiaries of such Policies may seek undue benefit\u2026","rel":"","context":"In "Case Briefs"","block_context":{"text":"Case Briefs","link":"https:\/\/www.scconline.com\/blog\/post\/category\/casebriefs\/"},"img":{"alt_text":"National Consumer Disputes Redressal Commission","src":"https:\/\/i0.wp.com\/www.scconline.com\/blog\/wp-content\/uploads\/2018\/08\/NCDRC_.jpg?resize=350%2C200&ssl=1","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/www.scconline.com\/blog\/wp-content\/uploads\/2018\/08\/NCDRC_.jpg?resize=350%2C200&ssl=1 1x, https:\/\/i0.wp.com\/www.scconline.com\/blog\/wp-content\/uploads\/2018\/08\/NCDRC_.jpg?resize=525%2C300&ssl=1 1.5x, https:\/\/i0.wp.com\/www.scconline.com\/blog\/wp-content\/uploads\/2018\/08\/NCDRC_.jpg?resize=700%2C400&ssl=1 2x, https:\/\/i0.wp.com\/www.scconline.com\/blog\/wp-content\/uploads\/2018\/08\/NCDRC_.jpg?resize=1050%2C600&ssl=1 3x"},"classes":[]},{"id":235380,"url":"https:\/\/www.scconline.com\/blog\/post\/2020\/09\/05\/ncdrc-to-determine-pecuniary-jurisdiction-of-district-commission-state-commission-or-national-commission-which-value-of-goods-or-services-has-to-be-considered-commission-elaborates\/","url_meta":{"origin":249811,"position":2},"title":"NCDRC | To determine pecuniary jurisdiction of District, State or National Commission which value of goods or services has to be considered? Commission elaborates","author":"Bhumika Indulia","date":"September 5, 2020","format":false,"excerpt":"National Consumer Disputes Redressal Commission (NCDRC):\u00a0A Division Bench of R.K. Agrawal (President) and Dr S.M. Kantikar (Member), held that \"...for detrmining the pecuniary jurisdiction of the District Commission, State Commission or National Commission the value of goods or services paid as consideration alone has to be taken and not the\u2026","rel":"","context":"In "Case Briefs"","block_context":{"text":"Case Briefs","link":"https:\/\/www.scconline.com\/blog\/post\/category\/casebriefs\/"},"img":{"alt_text":"National Consumer Disputes Redressal Commission","src":"https:\/\/i0.wp.com\/www.scconline.com\/blog\/wp-content\/uploads\/2018\/08\/NCDRC_.jpg?resize=350%2C200&ssl=1","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/www.scconline.com\/blog\/wp-content\/uploads\/2018\/08\/NCDRC_.jpg?resize=350%2C200&ssl=1 1x, https:\/\/i0.wp.com\/www.scconline.com\/blog\/wp-content\/uploads\/2018\/08\/NCDRC_.jpg?resize=525%2C300&ssl=1 1.5x, https:\/\/i0.wp.com\/www.scconline.com\/blog\/wp-content\/uploads\/2018\/08\/NCDRC_.jpg?resize=700%2C400&ssl=1 2x, https:\/\/i0.wp.com\/www.scconline.com\/blog\/wp-content\/uploads\/2018\/08\/NCDRC_.jpg?resize=1050%2C600&ssl=1 3x"},"classes":[]},{"id":44411,"url":"https:\/\/www.scconline.com\/blog\/post\/2016\/04\/20\/repudiation-of-insurance-claim-of-overloaded-bus-justified\/","url_meta":{"origin":249811,"position":3},"title":"Repudiation of insurance claim of overloaded bus, justified","author":"Sucheta","date":"April 20, 2016","format":false,"excerpt":"National Consumer Disputes Redressal Commission (NCDRC):\u00a0While observing that huge overloading of vehicles adversely affects the steering control and increases the chance of driver to loose control of the vehicle which may cause accident, NCDRC upheld the repudiation of insurance claim of a bus on the ground of over loading. Earlier,\u2026","rel":"","context":"In "Case Briefs"","block_context":{"text":"Case Briefs","link":"https:\/\/www.scconline.com\/blog\/post\/category\/casebriefs\/"},"img":{"alt_text":"National Consumer Disputes Redressal Commission","src":"https:\/\/i0.wp.com\/www.scconline.com\/blog\/wp-content\/uploads\/2018\/08\/NCDRC_.jpg?resize=350%2C200&ssl=1","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/www.scconline.com\/blog\/wp-content\/uploads\/2018\/08\/NCDRC_.jpg?resize=350%2C200&ssl=1 1x, https:\/\/i0.wp.com\/www.scconline.com\/blog\/wp-content\/uploads\/2018\/08\/NCDRC_.jpg?resize=525%2C300&ssl=1 1.5x, https:\/\/i0.wp.com\/www.scconline.com\/blog\/wp-content\/uploads\/2018\/08\/NCDRC_.jpg?resize=700%2C400&ssl=1 2x, https:\/\/i0.wp.com\/www.scconline.com\/blog\/wp-content\/uploads\/2018\/08\/NCDRC_.jpg?resize=1050%2C600&ssl=1 3x"},"classes":[]},{"id":99271,"url":"https:\/\/www.scconline.com\/blog\/post\/2017\/01\/13\/repudiation-of-claim-by-insurance-company-on-the-ground-of-failure-of-written-intimation-of-theft-of-vehicle-held-proper\/","url_meta":{"origin":249811,"position":4},"title":"Repudiation of claim by insurance company on the ground of failure of written intimation of theft of vehicle, held proper","author":"Saba","date":"January 13, 2017","format":false,"excerpt":"National Consumer Disputes Redressal Commission (NCDRC): \u00a0NCDRC has held that failure of the insured to give immediate information of theft in writing to the insurance company would entitle the insurance company to repudiate the claim. While observing this, NCDRC upheld the repudiation of insurance claim by Reliance General Insurance Co.\u2026","rel":"","context":"In "Case Briefs"","block_context":{"text":"Case Briefs","link":"https:\/\/www.scconline.com\/blog\/post\/category\/casebriefs\/"},"img":{"alt_text":"National Consumer Disputes Redressal Commission","src":"https:\/\/i0.wp.com\/www.scconline.com\/blog\/wp-content\/uploads\/2018\/08\/NCDRC_.jpg?resize=350%2C200&ssl=1","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/www.scconline.com\/blog\/wp-content\/uploads\/2018\/08\/NCDRC_.jpg?resize=350%2C200&ssl=1 1x, https:\/\/i0.wp.com\/www.scconline.com\/blog\/wp-content\/uploads\/2018\/08\/NCDRC_.jpg?resize=525%2C300&ssl=1 1.5x, https:\/\/i0.wp.com\/www.scconline.com\/blog\/wp-content\/uploads\/2018\/08\/NCDRC_.jpg?resize=700%2C400&ssl=1 2x, https:\/\/i0.wp.com\/www.scconline.com\/blog\/wp-content\/uploads\/2018\/08\/NCDRC_.jpg?resize=1050%2C600&ssl=1 3x"},"classes":[]},{"id":6382,"url":"https:\/\/www.scconline.com\/blog\/post\/2015\/02\/18\/repudiation-of-claim-on-ground-that-complainant-failed-to-prove-that-cause-of-death-was-a-result-of-accidental-injuries-upheld\/","url_meta":{"origin":249811,"position":5},"title":"Repudiation of claim on ground that complainant failed to prove that cause of death was a result of accidental injuries, upheld","author":"Sucheta","date":"February 18, 2015","format":false,"excerpt":"National Consumer Disputes Redressal Commission (NCDRC): NCDRC has upheld a repudiation of claim by an insurance company on the ground that complainant failed to prove that the cause of death of the insured was the injury caused by the accident. Earlier, complainant\u2019s mother obtained insurance cover from HDFC Ergo General\u2026","rel":"","context":"In "Tribunals\/Commissions\/Regulatory Bodies"","block_context":{"text":"Tribunals\/Commissions\/Regulatory Bodies","link":"https:\/\/www.scconline.com\/blog\/post\/category\/casebriefs\/tribunals_commissions_regulatorybodies\/"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/www.scconline.com\/blog\/wp-content\/uploads\/2015\/10\/scc-blog_Page_9.jpg?resize=350%2C200&ssl=1","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/www.scconline.com\/blog\/wp-content\/uploads\/2015\/10\/scc-blog_Page_9.jpg?resize=350%2C200&ssl=1 1x, https:\/\/i0.wp.com\/www.scconline.com\/blog\/wp-content\/uploads\/2015\/10\/scc-blog_Page_9.jpg?resize=525%2C300&ssl=1 1.5x, https:\/\/i0.wp.com\/www.scconline.com\/blog\/wp-content\/uploads\/2015\/10\/scc-blog_Page_9.jpg?resize=700%2C400&ssl=1 2x, https:\/\/i0.wp.com\/www.scconline.com\/blog\/wp-content\/uploads\/2015\/10\/scc-blog_Page_9.jpg?resize=1050%2C600&ssl=1 3x"},"classes":[]}],"amp_enabled":true,"_links":{"self":[{"href":"https:\/\/www.scconline.com\/blog\/wp-json\/wp\/v2\/posts\/249811","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.scconline.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.scconline.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.scconline.com\/blog\/wp-json\/wp\/v2\/users\/8808"}],"replies":[{"embeddable":true,"href":"https:\/\/www.scconline.com\/blog\/wp-json\/wp\/v2\/comments?post=249811"}],"version-history":[{"count":0,"href":"https:\/\/www.scconline.com\/blog\/wp-json\/wp\/v2\/posts\/249811\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.scconline.com\/blog\/wp-json\/wp\/v2\/media\/199533"}],"wp:attachment":[{"href":"https:\/\/www.scconline.com\/blog\/wp-json\/wp\/v2\/media?parent=249811"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.scconline.com\/blog\/wp-json\/wp\/v2\/categories?post=249811"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.scconline.com\/blog\/wp-json\/wp\/v2\/tags?post=249811"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}