Anurag (NA) 23 May 2013

Need guidance on dispuing group insurance claim

Hi All,

My brother died on 12-Dec-12 early morning and was working in his private IT company approx 4 hours before he died.His age was 33 and he was visibily healthy, lean and thin,with absolutely no previous history of any desease.He developed some visible complications while he was in office and there was complete medical negligence from mangment and proper care was not given to him for hours spent in office and he continued working there till 10:00 PM .Within 4 hours of exiting the office his condition deteriorated while he reached back home and turned un-concious , when I took him to hospital he died on the way to hospital ,where he was declared brought dead.Panchnama filed that time gave the understanding that the reason of death was Cardiac Arrest. Autopsy report says reason of death cannot be asertained.

I have series of question specially pertaining to Group Accidental Policy of the company and the compensation to be prvided to my parents in this case:

1. Company is denying the fulll payment under accidental coverage stating that this is a natural death and it is not a accidental one. My question is if the PM report is not clear regarding the cause of death ,can this be considered as Natural death, i.e. dying at the age of 33 without any previous history of any complications or desesase? Is this not an accident? Should I go ahead and dispute this?

2. If I need to dispute What are the Channels through which I can dispute? Should I dispute the Organization and Insurance Company both, I am new to legal things,any help will suffice.

3. OR Can I ask the organization to pay the compensation for medical negligence on there part if the insurance company is not paying.

4.Is there any Act or LAW which can help me get some insights.

5. Should I hire a lawyer?

6. Do i need to file the FIR to get the relevant documents from Police in this case, Can I get the "Inquest Report" from Police without filing an FIR.?

Regards

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3 Replies

Rama chary Rachakonda (Secunderabad/Telangana state Highcourt practice watsapp no.9989324294 ) 23 May 2013

Death can occur naturally, unnaturally or as the result of a combination of causes originating from oneself or another. While some cases consist of overt evidence that the death occurred naturally, others require an expert to determine the precise cause of death or combination of causes. A hospital-based pathologist’s training in determining the cause of death may not include the depth or breadth of the knowledge necessary to assess suspicious death cases. Therefore, expert forensic pathologists, such as those at The Forensic Panel, are able to assess whether or not the cause of death was unnatural. To do this, experts must be familiar with external stressors such as poisons, noxious substances and environmental diseases, as well as the subtle ways in which these stressors affect the body. The expert forensic pathologists at The Forensic Panel are trained in the detection of unnatural causes of death regardless of whether the identity of the body is known or the doubtful or questionable clinical history of the deceased.

Anurag (NA) 24 May 2013

Thanks for your comments Ramacherry Ji,

With your suggestion looks like I would be needing the Forensic report to identify if the death was natural or not. And I cannot win over my dispute with the insurance company or Organization without having forensic report in place ?

Can you suggest what should I do next to get it?

Regards

Anurag (NA) 01 June 2013

Dear All,

Request help over knowing theprocedure how to dispute the claim if the organization with which employee was working has sent to insurance company that the death is a natural one.Organization people are aware that the employee worked in office in deteriorating condition and no body from HR informed us about the problem, immediate taking him to hospital could have saved him.

To safeguard themselves for providing adequate compensation they declared the death as natural in the LIc's EDLI from and are saying that Accidental insurance is only applicable where there is road side accident only, i lost my brother at 33 which is un-natural and is a trauma for us, now not sure what should i do next.

Somebody please advice.