Manmeet Singh Gill
Tribune News Service
Amritsar, October 28
The district consumer disputes redressal forum has directed an insurance company to pay Rs 2,23,000 as an accidental death benefit to the wife of person who died of dengue. The forum has also directed the company to pay Rs 5,000 as litigation expenses.
Earlier, Shelly Arora, a resident of East Mohan Nagar, had filed a complaint against Kotak Mahindra Old Mutual Life Insurance stating that her deceased husband was insured with the opposite party. She stated that her husband had obtained a policy in July 2012 by paying an annual premium of Rs 15,600 for the sum assured Rs 2,23,000. In September 2016, he was diagnosed with dengue, so hospitalised. He died a few days later.
The complainant said the death summary of the deceased clearly revealed that his death was unnatural and it was due to the mosquito bite, which was covered in the accidental rider. She added that inspite of repeated requests and demands made by her, the opposite party processed the said claim as natural death and only paid the sum assured amount of Rs 2,23,000. She stated that she requested for the accidental rider sum assured of additional Rs 2,23,000 but the opposite party flatly refused to make the payment.
The opposite party, in its reply, stated that the Accidental Death Benefit Rider indicated that if the life insured dies of an accident and the beneficiary proves the same to the satisfaction of the company, the accidental death benefit rider sum assured will become payable subject to conditions. The conditions, as stated by the company, include that the life insured has sustained any bodily injury directly and solely from an accident, which has been caused by outward, violent and visible means and that the death occurs within 120 days of the date of accident due to such injury.
The reply stated that the complainant herself had ticked the column stating that the cause of death was natural and further the death certificate didn’t mention the cause of death as accidental.
The forum observed that the only contention of the opposite party was that the death of the life assured was not accidental. Disagreeing with the contention, the forum stated that mosquito bite was something which no one expected and which happened all of a sudden without any act or omission on the part of the victim.
It stated that an accident is something that happens unexpectedly and is not planned in advance.
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