Father Wins Rs 5 Lakh LIC Claim After Commission Finds Gaps In Evidence

Roop Singh challenged the Life Insurance Corporation of India’s (LIC) rejection of the death claim following his son Sukhdev Singh’s death in August 2023. LIC alleged that Sukhdev had withheld information about a heart procedure performed in 2008.

Why LIC’s Evidence Fell Short

The District Consumer Disputes Redressal Commission (DCDRC), Sri Muktsar Sahib, found problems with the proposal forms. One lacked a signature and date; another was dated after the policy’s issuance in April 2022.

LIC relied on treatment records from 2023 but produced neither records of the alleged 2008 procedure nor medical documents predating the policy.

What The Father Will Receive

The commission ordered payment of Rs 5 lakh, less any premium already refunded on an ex-gratia basis, with annual interest of seven per cent from January 29, 2024, until payment. It also awarded Rs 10,000 for compensation and litigation expenses. LIC was given 45 days from receipt of the order to comply, according to a recent Times of India report.

Check The Answers Before Signing

For someone buying life insurance, the paperwork can feel secondary to the premium and the amount of cover. Yet the answers entered in the proposal form deserve just as much attention. Keeping a copy gives the buyer a record of what was disclosed when applying.

Read each health question before signing. If an agent completes the form, go through the answers yourself. Do not leave this check until the policy arrives.

Where a question asks about previous operations, hospital admissions or treatment, provide the relevant information. Do not assume an old episode need not be mentioned because you have recovered or no longer take medicines. If the question is unclear, ask the insurer for written clarification and retain its reply.

Where supporting documents are available, keep them with the disclosures. A discharge summary, prescription or doctor’s note may help explain the treatment more accurately than a brief answer alone. Keep an acknowledgement of any additional information sent to the insurer.

Give The Nominee Access To The Documents

A nominee should know where the policy, proposal form, premium receipts and medical disclosures are stored. A folder containing these papers and the insurer’s contact details can spare the family a search when it needs to submit a claim.

If a claim is rejected, obtain the written reasons. Read the explanation alongside the proposal form and the records submitted. Identify what the insurer says was withheld, which question sought that information, and which documents support its allegation.

Prepare a short chronology of the application, policy issuance, treatment and claim correspondence. Keep copies of everything sent and acknowledgements of receipt. This can help the family present its objection clearly.

The insurance company’s customer guidance provides for complaints through its customer portal and other grievance channels. It also directs customers dissatisfied with the response to the Insurance Ombudsman.

When contesting a rejection, explain the disputed facts and attach the relevant papers. A complaint is easier to assess when it states precisely why the family disagrees with the insurer’s decision.

FAQs

Why did the consumer commission rule against LIC?
LIC did not produce medical records supporting the alleged 2008 heart procedure. The commission also found discrepancies in the proposal forms.

What compensation will Roop Singh receive?
The commission ordered Rs 5 lakh, minus any premium already refunded, with seven per cent annual interest from January 29, 2024, and Rs 10,000 for compensation and litigation expenses.

What should a nominee do if a death claim is rejected?
Obtain the rejection reasons in writing and compare them with the proposal form and medical disclosures. Keep relevant records ready when challenging the decision.