90-day limit no basis to deny insurance claim – The Economic Times–11.02.2018

The National Consumer Disputes Redressal Commission (NCDRC) has ordered an insurance company to pay Rs 2.5 lakh with 9% interest to the kin of a deceased who had died on the 90th day of the purchase of a policy.
The case refers to one Kulwinder Singh of Fazilka in Punjab, who had paid Rs 45,999 to HDFC Standard Life Insurance on May 26, 2010. He passed away due to a heart attack on August 25 in that year. When the family sought the full assured amount, the insurance firm paid them only the premium that Singh had paid.
While directing the insurance firm to pay the full assured amount, the single-member bench of M Shreesha also referred to an order from the insurance regulator IRDA on June 27, 2012 involving the same insurance company. Based on the order, NCDRC upheld that the insurance companies cannot apply the 90-day waiting period and reject claims. The IRDA had ordered Rs 1 crore penalty on the same insurance company for rejecting 21 claims citing the same 90 days waiting period.
The NCDRC also observed, “Even in the instant case, the deferred period was 90 days and it’s not as if the time of death was planned only to take advantage under the policy expecting that the insured may not live beyond the period of 90 days.”
Singh’s family submitted how the deceased had made the premium payment in cash on May 26, 2010 but the policy became effective from May 29. Singh’s family had pleaded that since the premium was paid in cash, so the risk cover began from that date.
The NCDRC also took into consideration of other policies held by the deceased from other companies. In those cases, the risk of coverage invariably begins from the date of proposal.

Singh’s family had moved the NCDRC in 2014 after the state consumer commission had turned down the order of district forum to pay Rs 2.5 lakh to Singh’s kin.

(This article was originally published in The Times of India)

via 90-day limit no basis to deny insurance claim – The Economic Times

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