The National Commission indicted LIC for working in cahoots with doctors for baseless certificates to repudiate claims and held this to be an unfair practice, points out Jehangir B Gai.
Photograph: Hitesh Harisinghani/Rediff.com
Kamaljit Singh had taken a Rs 2 lakh policy from the Life Insurance Corporation of India on April 28, 2002.
He fell ill and was admitted to the Munni Lal Chopra Hospital in Amritsar, where he died on January 12, 2004.
His widow Ranvir Kaur lodged a claim, but LIC repudiated it on the ground that Singh had been suffering from a chronic liver disease for about 18 months before his death.
The insurer claimed Singh had intentionally suppressed this fact when taking the policy.
Kaur filed a complaint before the Gurdaspur district forum, which directed LIC to settle the claim with nine per cent annual interest.
Additionally, Rs 10,000 was awarded as compensation for mental agony.
LIC appealed to the Punjab state commission.
The insurer relied on medical certificates from three doctors that claimed Singh was an alcoholic and had suffered cirrhosis of the liver, concealed while obtaining the policy.
The state commission upheld LIC's stand and set aside the district forum's order.
Kaur then approached the National Commission and contended Singh was a school teacher and a conscientious person who used to go for regular health check-ups. She produced the relevant reports.
He died due to an accident, which had no nexus with alcoholic cirrhosis of the liver.
To prove Singh had chronic liver disease, the insurer showed medical certificates and claimed the hospital where Kamaljit had expired made similar observations.
The National Commission scrutinised the certificates and observed Rajendra Kumar was not an allopathic doctor, as his qualification was BAMS, and the hand written certificate neither had any reference number nor date.
It did not give details about the treatment or investigations to conclude Singh was suffering from a chronic liver disease.
Similar observations were made about doctors Paramjeet Singh Dhaliwal and Yash Mehra. The medical record of the hospital showed was uncertain whether the liver problem was associated with alcohol.
The National Commission held no reliance could be placed on the certificates LIC had given.
It also observed LIC had not produced any evidence from the school or its staff where Singh worked, to back its allegations.
The National Commission indicted LIC for working in cahoots with doctors for baseless certificates to repudiate claims and held this to be an unfair practice.
Accordingly, by its order of February 2, 2017, delivered by S M Kantikar for the bench presided over by B C Gupta, the National Commission held in the absence of conclusive evidence that the liver problem was due to alcohol consumption, the claim could not be rejected.
It restored the order of the district forum holding that LIC was liable to settle the claim.
The Commission granted 90 days to comply with its order, or else the interest rate would stand enhanced from 9 per cent to 12 per cent for the period of delay.
A claim cannot be rejected on assumptions or on the basis of medical certificates which are vague.
Since cirrhosis can occur due to various reasons, it would be incorrect to jump to the conclusion that it was due to alcoholism.