Jagveer Singh filed a complaint against the decision of BB Life Insurance Corporation of India relating to rejection of death claim in respect of his wife on the ground of Suicide clause. The complainant stated that his
CS Professional · Insurance - Law & Practice · PYQS · December 2019
Jagveer Singh filed a complaint against the decision of BB Life Insurance Corporation of India relating to rejection of death claim in respect of his wife on the ground of Suicide clause. The complainant stated that his wife had taken the said policy from BB Life Insurance Co. Aligarh Division. She died on 27-3-2016 due to burn injury during the treatment at J.N. Medical College, Bulandshahr. The Complainant submitted the claim with all documents before the Insurance Company but his claim was rejected by the Company on the ground of suicide clause of the policy. The complainant stated that it was a case of accident and not of suicide and his claim was genuine and should be paid by Company. The Insurance Company stated that the deceased falls under category III female live as per underwriting norms of Insurance Company. The insured expired due to 90% thermal burn during treatment at J.N. Medical Hospital Aligarh on 27-3-2016 i.e. only after 8 months 28 days from the date of proposal and the claim was under the category of very early claim. Hence the matter was investigated by Insurance officer, during investigation the statements of two neighbors were taken into consideration and in their written statement, ex-pradhan informed that the deceased had committed suicide. Insurance company could not produce any other proofs as the FIR was lodged but no action/enquiry was made by the police as both the parties had reconciled the matter between themselves. Police Report mentioned that death is due to burn injuries, because of bursting of stove while cooking. The Reports of Postmortem also endorsed the Police Report. But the insurance company repudiated the claim on the ground of suicide clause under policy condition, which states "if the life assured (whether sane or insane) commits suicide at any time within 12 months from the date of commencement of risk, the corporation will not entertain any claim under this policy except to the extent of 80% of the premium paid excluding any taxes, extra premium and rider premiums, if any, provided the policy is." Based on above answer the following: Is the repudiation of the claim by the insurance company is justified in this case?
Answer & Explanation:
The repudiation of the claim is not justified by the insurance company, in the given case, although the Insurance Company submitted the statements of two neighbours of the deceased in support of repudiation of the claim, which were not found actionable evidence. But, still not convinced with the proof, the Insurance Company was therefore asked to submit some other proof to establish that the insured had committed suicide, which they could not submit. Secondly, the police report clearly speaks of burn injury due to bursting of stove while cooking. Similarly, the post mortem and other reports also speak of death due to burn only. Hence, the allegation of suicide by the insurer finds no documentary support. Hence, in the absence of any hard evidence, benefit of doubt should go in favour of complainant. Hence the claim is payable.
Topics: Life Insurance
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