The Goa State consumer’s disputes redressal commission passed an order favoring insurance company, stating that the company had rightfully rejected a claim. This order was passed overruling the order of North Goa district consumer dispute redressal forum.
The fact of the case is that the deceased had taken a group insurance policy along with a housing loan of Rs. 10 lakhs from State Bank of India. At the time of availing the policy, he willfully gave mis declaration to avail the policy.
Nearly 10 months after obtaining the policy he was admitted to hospital and was detected for cirrhosis of lever. In addition to this, the report also read that he has a history of known case of diabetes mellitus. Later on he was admitted to big hospital for further treatment. There it was identified that he had a history of diabetes, was a chain smoker and chronic alcoholic for 20 years. The deceased died after one month of hospitalization. The hospital’s death summary listed a long list of medical condition including alcoholic lever diseases.
On claiming death insurance from SBI Life Insurance Company, the company rejected the claim stating that the deceased had given wrong information and the policy clause stated that the assurance will be null and void if any mis – declaration is made or information is conceded.
Aggrieved by the rejection of the claim by SBI, the wife of deceased approached the district forum who ruled in favor of the wife of the deceased.
Not satisfied with the order of the district forum, the company approached State Consumer’s disputed redressal commission. The commission observed that the deceased had obtained the insurance policy by willfully suppressing the facts, giving false answers and thus playing fraud. The commission, after studying all the facts set aside the order of the district forum and said that the company has rightfully rejected the claim.