1 week ago
Himachal Commission Orders LIC Payment Over Covid Insurance Claim
A mother asked LIC for insurance money after her son died during the Covid-19 pandemic.
LIC refused to pay, saying the son had earlier breathing problems that were not mentioned in the insurance form.
The mother said there was no proof that he had such problems since childhood.
A consumer commission in Himachal Pradesh agreed with her.
It said LIC had not provided specific medical evidence to support its argument.
The commission ordered LIC to pay Rs 2 lakh under the policy.
It also ordered Rs 20,000 for the trouble caused and Rs 5,000 for legal costs.
The son had been insured from November 15, 2020, and died on May 8, 2021.
The ruling says insurers must prove alleged undisclosed illnesses before rejecting a claim.
A Himachal Pradesh consumer commission ordered LIC to pay Rs 2 lakh in insurance.
The commission also awarded Rs 20,000 compensation and Rs 5,000 in litigation costs.
The claim concerned a son with Down syndrome who died on May 8, 2021.
LIC argued that he had a childhood history of respiratory problems that was not disclosed.
The commission found no specific medical evidence proving those earlier respiratory problems and rejected LIC’s defence.
- Who
- A mother, her deceased son, and the Life Insurance Corporation of India were involved; the Himachal Pradesh consumer commission issued the order.
- What
- The commission directed LIC to pay Rs 2 lakh in insurance, Rs 20,000 in compensation, and Rs 5,000 in litigation costs.
- Where
- Himachal Pradesh, India.
- When
- The son died on May 8, 2021; LIC rejected the claim in November 2021; the commission’s order was dated August 7.
- Why
- LIC rejected the claim alleging that the son’s previous respiratory problems had not been disclosed, but the commission found no specific evidence establishing those problems since childhood.
Consumer Commission’s Finding
LIC’s Defence
Alleged prior respiratory illness
Consumer Commission’s Finding
The commission said LIC provided no specific and cogent medical evidence that the son had breathing or respiratory problems since childhood.
LIC’s Defence
LIC argued that the son was a known case of Down syndrome with respiratory difficulty occurring on and off since childhood.
Disclosure in the proposal form
Consumer Commission’s Finding
The commission found that the son had not been shown to have concealed a previous history of respiratory or breathing problems.
LIC’s Defence
LIC said the proposal form answered illness-related questions negatively and deliberately suppressed the son’s previous medical history.
Insurance claim
Consumer Commission’s Finding
The commission held that the mother was entitled to the Rs 2 lakh insurance amount and had been harassed by the claim rejection.
LIC’s Defence
LIC argued that the alleged nondisclosure and the son’s death meant the mother was not entitled to the claim.
Key facts
- Insurance amount
- Rs 2 lakh
- Compensation
- Rs 20,000
- Litigation costs
- Rs 5,000
- Total ordered payment
- Rs 2.25 lakh
- Policy commencement
- November 15, 2020
- Date of death
- May 8, 2021
- Claim rejection
- November 2021
Quotes
Himachal Pradesh consumer commission
The state consumer commission panel that adjudicated the mother’s insurance complaint
“In the absence of any specific and cogent evidence that complainant’s son was having any breathing/respiratory problem since his childhood, therefore, we are not in agreement with the plea of the opposite party (LIC) that the deceased had concealed his previous medical history of respiratory/breathing problem in the proposal form.”
indianexpress.com
Sources
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