The District Consumer Disputes Redressal Commission in Sri Muktsar Sahib, Punjab, has ordered the Life Insurance Corporation of India to pay a Rs 5 lakh death claim to the father of a 30-year-old government employee who died of a heart attack, holding that the insurer unlawfully denied the payout on unproven claims of medical suppression.
The commission, comprising president Ashok Kumar Garg and member Tajinder Kaur, determined that LIC’s repudiation constituted a deficiency in service. In its September 1 order, the bench also directed the public sector insurer to pay Rs 10,000 to the father to cover compensation and litigation expenses.
Insurer Alleged Concealment Of Childhood Surgery
The dispute originated after the policyholder died in August 2023, following which his father, named as the policy nominee, filed for the Rs 5 lakh sum assured. The policy had been acquired in April 2022 with a maturity date scheduled for April 2043.
LIC rejected the claim in January 2024 and subsequently dismissed an appeal, asserting that the policyholder had withheld critical health information when submitting his application. According to the insurer, the man had an Atrial Septal Defect/Ventricular Septal Defect closure and a Fontan open-heart procedure in 2008 to treat a hole in his heart.
The insurer maintained that the applicant answered in the negative to medical questions on the proposal form despite knowing his condition, adding that coverage would have been refused had the prior treatments been revealed.
Unverified Forms And Missing Medical Records
The father challenged the rejection before the consumer commission, arguing that the alleged surgery took place when his son was a minor, more than 14 years before the insurance was purchased. He also contended that LIC provided no evidence establishing a link between the childhood procedure and his son’s fatal heart attack.
Upon examining the case, the commission found that LIC failed to place any clinical or hospital documentation on record to substantiate the 2008 heart procedures cited in its rejection letter.
The panel also highlighted procedural flaws in the documentary evidence presented by LIC. The proposal form submitted by the company was only two pages long and lacked both the submission date and the applicant’s signature, leading the commission to question its authenticity and reliability.
Fourteen-Year Gap Rules Out Fraudulent Intent
The commission further observed that the insured individual was 30 years old and employed in government service, a role that typically requires medical screening and a fitness certificate prior to appointment.
Addressing the timeline, the bench noted that even if the surgical procedure had occurred in 2008, the policy was taken nearly 14 to 15 years later in April 2022. Because of this substantial passage of time and his subsequent death in August 2023, the commission concluded it could not be presumed that the deceased obtained the policy with dishonest intentions or with awareness that he was suffering from a severe condition at the time of purchase.
