Insurance law - related to claims

Querist : Anonymous (Querist) 03 October 2011 This query is : Resolved
In case of young deaths where the doctor has advised a post mortem to be done, but is not done by the family of the deceased, does the insurance company have a right to reject the claim on grounds of "cause of death uncertain"?

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Sailesh Kumar Shah (Expert) 03 October 2011
What is the reasons of death?

ajay sethi (Expert) 03 October 2011
yes post mortem report is necessary to ascertain the cause of death when cause of death is uncertian

Querist : Anonymous (Querist) 03 October 2011
There is doctor statement that he was called at home and found the insured dead upon inspection. The certificate further states that the cause of death could be heart attack and that he had advised the family of the deceased to do a post mortem. However, the family has not done the PM.

Querist : Anonymous (Querist) 03 October 2011
Note that the insured was only 30 years old at the time of death

Sailesh Kumar Shah (Expert) 03 October 2011
So,Insurance company have valid ground for deny.

Querist : Anonymous (Querist) 03 October 2011
do we have any case laws to support this?

Sailesh Kumar Shah (Expert) 03 October 2011
Check insurance company terms and conditions also policy documents.

ajay sethi (Expert) 03 October 2011
when insurance policy was taken did you declare pre existing disease? that the deceased had history of heart problems?

if you ahve declared then if doctors says the deceased died of hear attack you may not face problems .

on other hand if you have not declared and he died of heart attack and inspite of doctor advice post mortem was not done it raises suspcions that you are trying to mislead the insurance company and make false claim .