Case Study 48 - No FIR, post-mortem report needed for insurance claims for injuries at home

The Consumer Disputes Redressal Forum, Ahmedabad (Rural), has directed United India Insurance Company Ltd to pay Rs one lakh with nine per cent interest till the date of payment to a widow for causing mental agony and harassment.

The forum held the insurance company, its Ahmedabad Regional Office, and its office at Palanpur, Banaskantha district, guilty of deficiency in service in a case filed by the Consumer Education and Research Society (CERS) and Mrs Jyotsna Ambalal Patel.

The forum also directed the insurance company to pay Rs 5,000 towards her mental agony and harassment, and Rs 1,000 towards cost and another Rs 1,000 to CERS as costs, Ms Preeti Shah, Chief General Manager, CERC, said in a statement here on Monday.

The woman’s husband, Ambalal, had been insured for Rs one lakh under a group insurance scheme of United India Insurance through the Kadi Taluka Madhyamik Shala Karmachari Dhiran Grahak Mandali Ltd, Kadi, and the Mehsana-Patan District Cooperative Credit Societies Federation Ltd, Mehsana.

Ambalal had died in a hospital in February 2008 after a severe head injury at his residence. When Jyotsna claimed the insurance money and submitted all necessary papers to the company, the company rejected the claim on the ground that neither a first information report (FIR) nor a post-mortem examination report had been submitted.

Citing precedents, the complainants stated that when a person dies following a serious injury suffered at home, the case did not warrant an FIR, or a post-mortem report, that was also corroborated by the report of the hospital where Ambalal died.