life insurance claim
shradha vidyarthi
(Querist) 08 November 2016
This query is : Resolved
Sir, what is remedy for life insurance claim denial on the basis of section 45 of insurance act. District consumer fourm rejected ccomplainant case on 2 points that 1. Assured did not disclose previous policies and 2. Assured had old diseases. While assured had policies of other insurance company but he had not any old disease. What can we do . We opt for appeal in state cCommission but how should we go and what point should consider.please explain.
Kumar Doab
(Expert) 08 November 2016
The Insurer has only 3 years window for calling a policy in question on the ground of misrepresentation or suppression of a material fact not amounting to fraud, from the date of issuance of Policy or date of commencement of risk or date of revival of policy or date of rider of the policy, whichever is later. It is regardless of whether claim has arisen or not and when it is intimated. Once this period of 3 years is over, the policy cannot be called in question.
Your own counsel would have advised you on why you lost in DCDRF and what next should be done.
What is your own counsels opinion?
Rajendra K Goyal
(Expert) 08 November 2016
Full case file and orders of consumer forum need to be referred, discuss with your lawyer.
Kumar Doab
(Expert) 09 November 2016
There are counsels that have earlier with LIC.
Prefer second opinion from a very able counsel specializing in consumer matters and well versed with insurance claims.
krishna mohan
(Expert) 09 November 2016
It is noted that District consumer fourm rejected ccomplainant case on 2 points that 1. Assured did not disclose previous policies and 2. Assured had old diseases. Regarding previous policy, any claim preferred and settled for the same disease? If so this could a ground for challenging. Regarding pre existing disease, there may be a lock in period during which no claim is admissible. You may approach able counsel in your area with answer for the above so that your right for appeal is preferred within the time limit.
Kumar Doab
(Expert) 09 November 2016
You are yourself a trained lawyer.
Must be able to find out other counsels that are specializing in such/consumer/insurance matters.
Consult them.
Rajendra K Goyal
(Expert) 09 November 2016
Show the case file to your lawyer to find grounds to challenge the decision of consumer forum.
H.M.Patnaik
(Expert) 09 November 2016
Since, the case has been rejected by Dist. forum, the reasons must have been spelt out on body of the order itself.Pl. check up the order as well as underlying facts to an counsel having experience in Life insurance claim matters , so that all possible grounds for appeal can be finalised and properly contested.
Rajendra K Goyal
(Expert) 07 December 2016
May proceed as advised as advised by the expert.
Kumar Doab
(Expert) 07 December 2016
Hope you are satisfied.
