Reliance Insurance asked to pay Chikkadpally resident Rs 60K as compensation

Gurikan Tulasi's husband Gurikani Rama Swamy, a resident of Chikkadpally, was the insured and owner of the car that was also insured with the opposite party. An amount of Rs. 18,996 had been paid for the same and the Reliance passenger carrying vehicle package policy commenced from 1 December 2016 to 30 November 2017. Rs. 100 was also paid to the opposite party towards compulsory personal accident (PA) of owner-driver (IMT-15). Ms. Tulasi was the nominee of the deceased.

On 21 May 2017, Rama Swamy died in an accident at Narayanaguda. After all the rituals were completed, Ms. Tulasi, on 30 October 2017, informed the opposite party about the accidental death of her husband/insured and owner.

The insurance agent visited her residence and obtained all relevant information regarding the death and particulars and also obtained her signatures on the required documents.

"Subsequently, as there was no communication or reply from the opposite party in spite of several phone calls, I was compelled to approach an advocate who has verified from the website of the insurer and informed me that the claim had been repudiated without giving any reasons," said Ms. Tulasi.

The complainant alleged that this act of repudiation and not intimating her about the repudiation of the claim amounts to deficiency of service on the part of the opposite party. The repudiation is arbitrary, illegal, and against the principles of natural justice.

The insurance company, meanwhile, said the complainant is not the nominee of the insured/deceased and that she lied about the accident. In fact, it was not an accident but death due to heart attack, it alleged. "Any claimant has to furnish certain documents along with the claim form and the complainant also furnished the FIR copy, inquest report, and post-mortem report. In all these three documents it has been clearly stated that the death was due to myocardial infarction i.e. heart attack," said the insurance company.

After going through the evidence and hearing the arguments, the forum said: "The opposite party has resisted the complaint by alleging that as the complainant is not the nominee of the policyholder, she is not eligible for the claim. But the opposite party had never denied nor disproved that the complainant is not the wife of the policyholder. Though her name does not reflect in the nominee clause she as a beneficiary is entitled to the insurance claim."

It also added that the FIR filed at Narayanguda police stations states that the insured man was found dead in the insured car on a busy road at Narayanguda flyover. "Though the post-mortem report says that the cause of death is heart attack, there is no proof to show what caused the heart attack. Under the given circumstances, an inference can be drawn that the heart attack occurred due to shock on the busy road," said the forum.

The forum said the opposite party had been deficient in its services by repudiating the claim of the complainant. It asked the insurance company to pay a sum of Rs. 2 lakhs with interest at nine per cent from the date of repudiation. Also, the company was asked to pay a compensation of Rs. 50,000 for causing inconvenience and mental agony and Rs. 10,000 towards the cost of litigation.