The insurer, during the hearings, was unable to produce any evidence showing that the policyholder had a history of kidney disease or that he was undergoing treatment prior to or during the term of the policy
Five years after the sudden death of her husband, a Hyderabad woman has finally secured the insurance money that was rightfully hers. V. Thara, whose husband, V. Venugopal, who passed away in 2019, will receive Rs 50 lakh after the Telangana State Consumer Commission ruled in her favour, ending a protracted legal battle against a private life insurance company.
Venugopal had taken out a life insurance policy worth Rs 50 lakh in November 2018. He died in August 2019, reportedly from a sudden cardiac arrest. His wife, Thara, who was named the nominee, submitted the claim shortly after his death.
Insurer Rejected Claim On Grounds Of A Pre-Existing Disease
However, the insurance company rejected the claim in November 2019. The reason given was that the policyholder had failed to disclose a pre-existing medical condition.
According to the insurance company, Venugopal was suffering from a condition called chronic kidney disease (CKD) and was undergoing dialysis, and had not revealed those at the time of purchasing the policy, according to a report in the Times of India.
However, Thara did not accept the rejection and approached the State Consumer Disputes Redressal Commission. She said her husband was not undergoing any dialysis at the time of buying the policy and also had never received treatment for kidney failure. The commission went through all the documents and medical records submitted by both parties.
Insurer Unable To Produce Required Evidence
During the hearings, the insurer was unable to produce any evidence showing that Venugopal had a history of kidney disease or that he was undergoing treatment prior to or during the term of the policy. The commission also noted that the insurer had not conducted any pre-policy medical tests, even though they had the authority to do so.
In its order, the commission stated that the insurer’s refusal to settle the claim amounted to a deficiency in service and an unfair trade practice. It directed the company to pay Rs 50 lakh with nine per cent interest from November 2019. Additionally, the insurer was asked to pay Rs 2 lakh for causing mental agony to the complainant and Rs 25,000 towards legal expenses.
Thara said the order has come as a huge relief after years of emotional and financial struggle.
The delay in receiving the insurance amount added to her distress as she was left alone to take care of her three children.
“This is not just a win for me, but for many others who are forced to run from pillar to post despite holding valid policies,” she said.