Anil Kumar, a cloth trader, has taken four policies from Life India Insurance Corporation (LIC).
The first two policies respectively Rs 5 Lakh in 2003.
In 2005, he took the third and fourth policy of 12 lakh and RS 4 lakh respectively.
Total coverage under four policies came to RS 26 lakh.
His father Vijay Pal Singh is a candidate in all policies.
Anil died in the road accident on July 31, 2006.
His father Vijay filed a claim under four policies, but no one was resolved even though reminders and follow-up.
So Vijay filed a complaint before the Uttar Pradesh consumer commission.
Lic opposed this case, stating that a comprehensive investigation was needed because of high-value claims.
It agreed to complete the claim of Rs 5 Lakh each under the first two policies.
However, two claims for the policy taken in 2005 were rejected on the grounds that insurance coverage from HDFC standard life insurance and Tata AIG life insurance was not disclosed when sending a proposal form to LIC.
The State Commission partly allows complaints.
Both Vijay, as well as LIC, appeal to the order.
The National Commission relies on the Supreme Court’s decision that insurance fraud will be determined based on the definition under the Regulatory Law and Insurance Development (IRDA), and that the explanation based on contract action will be irrelevant.
(The author is a consumer activist and has won the Government of the Indian National Youth Award for consumer protection.
The email is Jehangir.Gai.columnist @ outlook.in)
The burden to prove fraud is in the insurance company, or must pay a claim
