Posts Tagged ‘Autopsy not must to claim insurance in accident death’

Autopsy not must to claim insurance in accident death

 

In case of an accident, normally a post-mortem is conducted to rule out foul play. But is it mandatory for a postmortem to be performed in each and every accidental death case? It is quite common to find families reluctant to subject their loved ones to a postmortem. So can the absence of a post-mortem be a ground for the insurer to repudiate a genuine claim?

Case study: C Mohan Reddy had taken four insurance polices from Life Insurance Corporation of India (LIC). On 9.5.2014, he suffered an electric shock from the water heater in the bathroom. His family rushed him to Kakatiya Hospital in Hyderabad where he was pronounced dead on arrival. The family did not opt for a post-mortem and the hospital also issued a death certificate certifying the cause of death to be due to electrical shock.

His widow Challa Yadamma later lodged claims under the four policies. LIC refused to settle the claims, saying that neither had an FIR been lodged with the police nor had a post -mortem been conducted.

Aggrieved by the repudiation, Yadamma filed a complaint before the District Forum and LIC contested the case. The district forum held the claims were payable and ordered LIC to make the payment.

LIC challenged the order, but its appeal was dismissed by Telangana State Commission, which upheld the District Forum decision. LIC then approached National Commission.

In its order of 13.7.2018 delivered by justice V K Jain, the National Commission noted that the only issue to be determined was whether Mohan Reddy had died due to an electrical shock or not. It observed that when the family rushed Mohan Reddy to the hospital without even knowing whether he was alive or dead, their sole intention was to save his life. Hence, the family would narrate the correct facts and there could be no reason to give a wrong history or make a false statement to the hospital, the order said. Besides, even the hospital had issued a death certificate recording the cause of death to be due to a shock.

The commission also observed that LIC’s demand for an FIR was not justified when death had taken place due to an accidental electric shock at home. The commission pointed out that there was no legal requirement of subjecting a dead body to post-mortem when foul play was not suspected.

The commission concluded that the claims had been wrongfully repudiated. It dismissed LIC’s revision and held it liable to pay the claim as per the policies.

Conclusion: When the cause of death is clear and foul play is not suspected, it is not mandatory to get a post-mortem. This judgment will be a major relief as a post-mortem puts a family to considerable anguish and harassment at the time of their bereavement.

The author is a consumer activist and has won the Govt.

of India’s National Youth Award for Consumer Protection. His email is jehangir.gai.columnist@outlook.in

Be the first to comment - What do you think?  Posted by admin - July 23, 2018 at 7:25 pm

Categories: Consumer Rights   Tags:

© 2010 PupuTupu.in