Noida: The district consumer commission has held Religare Health Insurance (now known as Care Health Insurance) of Religare Enterprises Limited guilty of deficiency in service for rejecting an accidental insurance claim filed by a woman whose husband died of electrocution in 2018.On March 5, commission president Anil Kumar Pundir and member Anju Sharma asked the insurer to pay the full claim amount of Rs 10 lakh with 6% interest per annum from the date the application was filed in 2019, and also to pay Rs 5,000 as compensation. The commission held that the insurer should not have insisted on a police report and autopsy for an electrocution death that occurred at home.Salarpur Khadar resident Babita Devi had approached the commission seeking direction to Religare Health Insurance, after her claim for payment of accidental death benefit was rejected on the grounds of incomplete papers. Her husband, Krishna Kumar Tiwary, who worked for Jaguar Security Services Pvt Ltd, was insured for accidental death through a Religare Health Insurance policy for him.“According to the policy, if the insured dies in an accident, the company will pay an accidental death claim of Rs 10 lakh to a family member,” she said, adding that on July 23, 2018, her husband suffered an electric shock at home and died during treatment the same day. She applied for a claim on Oct 11, but it was rejected on the grounds of incomplete paperwork.She told the commission that the insurance company demanded an FIR, post-mortem, and police investigation report. However, no police formalities were carried out, given that the accident occurred at home and did not warrant any police intervention.Filing a counterclaim, the insurance company denied any deficiency in services on its part and said the complaint was based on unsubstantiated facts. Challenging the commission’s jurisdiction to hear the complaint when an ombudsman was established by the Insurance Regulatory Development Authority, the insurance company agreed that Tiwari was covered by a group secure insurance policy issued to Jaguar Security Service Pvt Ltd.“The complainant submitted a claim on July 23, 2018, for treatment at Prayag Hospital, Noida, for accidental electric shock. After receiving the claim, the opposing insurance company sent letters dated Aug 26, 2019, Sept 5, 2019, and Nov 30, 2019, requesting certain documents. However, despite several reminders, the complainant did not provide the documents and information, following which the claim was closed,” counsel for the insurance company said.They further acknowledged that another claim for reimbursement after the death of the policyholder was placed, which was rejected as early as Dec 15, 2018. The commission concluded that the complaint clearly stated that her husband’s death was not the result of an accident requiring police action.
