Insurance Company Forced to Pay Rs 50 Lakh for Unjustified Claim

Kurnool: A landmark decision by the District Consumer Disputes Redressal Commission in Kurnool has required HDFC Life Insurance Company Limited to pay a substantial sum of Rs 50 lakh to the wife of a deceased doctor, Dr G. Sravan Kumar. The order was issued after a thorough investigation into an unjustified rejection of an insurance claim.

Dr Sravan Kumar, who worked as an ICU duty doctor and anesthesia specialist at a private hospital in Kurnool, passed away suddenly due to cardiac arrest on February 16, 2024. His wife, Bonthala Sindhuja, immediately submitted an insurance claim under the 'HDFC Life Click 2 Protect Super Policy,' which had a sum assured amounting to Rs 50 lakh. However, the insurer denied the claim citing non-disclosure of existing life insurance policies by Dr Sravan Kumar.

The Commission's ruling highlighted several critical issues in how the insurance company handled the case:

Insurer's Flaws According to Commission

• The proposal form contained ambiguous questions regarding the disclosure of existing policies, particularly those issued by other insurers.
• This ambiguity could not be held against the insured individual and must be interpreted in favor of the insurer, thus undermining Dr Sravan Kumar's rights.
• No evidence was provided to link any alleged non-disclosure with his sudden cardiac arrest that led to his death.
• The review by the insurer's Claims Review Committee was described as mechanical and lacking in thoroughness.

While only partially allowing the complaint, the Commission directed HDFC Life's manager in Mumbai and claim manager in Kurnool to jointly and severally pay Rs 50 lakh along with a compensation of Rs 50,000 and litigation costs of Rs 10,000 within 45 days. If they fail to comply, the unpaid amount will attract an annual interest rate of 12 per cent.