NCDRC Upholds Rejection of Insurance Claim on Accidental Death due to Lack of Documentary Evidence
Moneylife Digital Team 28 April 2023
Setting aside an order passed by the Kurukshetra district consumer dispute redressal forum, the national consumer disputes redressal commission (NCDRC) reiterated that, for claiming insurance on accidental death, all relevant documents need to be submitted. 
In an order, the bench of Dr SM Kantikar (presiding member) says, "Evidently, the complainant failed to prove that the death of her husband was accidental because there was no first information report (FIR), no post-mortem report, no statutory compliances made by the complainant, therefore, in my view, the order of the state commission cannot be faulted."
While the district forum had directed Oriental Insurance Co Ltd to pay Rs5 lakh death claim along with an interest of 10%pa (per annum) to Kurukshetra-based Anju Goel, the Haryana state consumer dispute redressal commission had set aside the order. 
The state commission, in its order, stated, "From the evidence produced on record on behalf of the opposite parties, it is a case of no evidence. The complainant was asked to submit some relevant documents, i.e. proof of the accident, police report, medico-legal report or post-mortem report and death certificate of the life assured, but the complainant failed to produce the relevant documents. There is no evidence to prove that the life assured had died in an accident. Thus, in the absence of any documentary evidence, the complainant cannot be allowed to pay any insurable benefits with respect to the policy obtained by the life assured."
The case is related to an insurance policy obtained by Kurukshetra-based Bushan Lal Goel from Oriental Insurance. On 4 December 2001, he died due to a fall from his motorcycle. His wife, Anju, submitted a death claim with Oriental Insurance. However, the claim was rejected. Oriental Insurance cancelled the policy and sent a cheque for Rs764 as a refund of the premium for the unexpired period. 
Ms Goel then filed a complaint before the district forum claiming compensation of Rs5 lakh as insured amount with interest and Rs10,000 as litigation cost. 
During the hearing, Oriental Insurance alleged that Ms Goel filed the complaint with unclean hands. "Her husband did not die in the accident. She has not filed FIR or post-mortem report to prove that it was an accidental death," it contended.
The district forum rejected the contention, while asking Oriental Insurance to pay Rs5 lakh with an interest at 10%pa from the date of filing the complaint till realisation.
Oriental Insurance challenged the order before the state commission, which set aside the order of the district forum. It says, "...under the facts and circumstances of the case we are of the view that the district forum has committed great error while passing the order dated 1 October 2003 and as such the impugned order is not sustainable in the eyes of the law". 
Ms Goel then approached the NCDRC. After hearing both sides and perusing material on record, including the original record requisitioned from the district forum, Dr Kantikar noted that without any documentary evidence, Ms Goel failed to prove that the death of her husband was accidental.
Confirming the order passed by the state commission, NCDRC dismissed the appeal filed by Ms Goel.
(Revision Petition No1162 of 2011  Date: 21 April 2023)
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