`Insurer can't deny claim citing lack of post-mortem'





A consumer forum has held that the absence of a post-mortem report cannot be a ground for repudiation of an accidental death insurance claim in cases where the police are sure about the cause of death and there is no confusion.

On Wednesday , the forum directed New India Assurance to pay the widow of a 45-year-old man who died of snake bite in 2008 the insured amount of Rs 5 lakh, along with a compensation of Rs 1.05 lakh. Holding the company guilty of indulging in unfair trade practice, the forum said, "Depending upon the situation and circumstances and reports of the medical officer, the hospital as well as the police, the claim should have been sanctioned on humanitarian grounds. There is no proof to show that there was any mischief or mala fide intention of the complainant in demanding the claim."

The forum rejected the insurance company's defence that it was not in the domain of the police to conclude the cause of death and that the job was of medical doctors, and that despite the advice of doctors, the woman--Dombivli resi dent Usha Bhoir--had failed to allow the post-mortem.

"The police are also a government and responsible investigative authority . As they were sure about accidental death, they did not go for post-mortem. So, merely saying that a post-mortem was not done and hence claim is repudiated is unfair," the forum said.

The forum observed that Bhoir could not have insisted on a postmortem and the final authority in the matter was the police. It pointed out that the police had recorded the statements of witnesses, conducted a panchnama and finally on July 10, 2008, had submitted a summary report to the sub-divisional magistrate, stating that the death was accidental.

Bhoir's husband Ashok had taken membership of a luxury club in Prabhadevi in 2007. The club had a tie-up with the insurance company and as per rules insured its members. In her complaint to the Central Mumbai District Consumer Disputes Redressal Forum in 2012, Bhoir said that on June 22, 2008, at 3pm, her husband had gone into the cattle shed on their premises, where he was bitten by a snake hidden in the grass. Ashok was taken to hospital, where at 9.15pm he suffered cardiorespiratory failure due to poisoning and died.