Insurer fakes certificate to deny death claim, fined
(This story originally appeared in
on Nov 02, 2022)AHMEDABAD: A Consumer Dispute Redressal Commission, Ahmedabad (city), has fined an insurance company and asked it to pay Rs 1 lakh in compensation to an insurance claimant after it was found the insurer furnished a fake medical certificate to deny insurance amount. The court also ordered the insurer to pay Rs 10 lakh death claim.
While penalising the insurance company, the commission's president observed that he and other members have experienced that insurers resort to false and frivolous pleas to avoid paying insurance amount and "also dare to produce false, fake and bogus documentary evidence". The commission deprecated insurers' attitude and said it was necessary to impose compensation of considerable amount as a deterrent for companies.
One 19-year-old Anil Desai from Bijadevi village of Nandurbar in Maharastrha was sold Rs 10 lakh life insurance policy by Bharti Axa Life Insurance Co Ltd in November 2015. The youth fell ill in August 2016 and consulted one Dr M A Shaikh in Shifa Clinic and was diagnosed with 'right hypochondric' pain and fever. He died on September 1. His mother, Savitriben, claimed the insurance amount from the company, which refused the claim on the ground that Desai had pre-existing disease and he hid the fact while obtaining the insurance policy.
Savitriben sued the insurance company with the district commission and produced a certificate issued by Dr Shaikh stating that he treated Desai on August 28, 2016, and the patient died four days later. In reply, the insurance company furnished another certificate issued by Dr Shaikh, in which it was mentioned that Desai was suffering from renal disease for the last three to four years.
The doctor was called for an examination and he made it clear that the certificate produced by the insurance company was never issued by him. The commission noticed that hand writings in both the certificates are different. The doctor said that the signature on the certificate produced by the company was not his and alleged that one of representatives from the insurer might have obtained a blank letterhead from his clinic. Moreover, it had many grammatical and spelling mistakes.
The commission concluded that the insurer had produced a fake and bogus document to refuse the insurance amount. It ordered the company to pay Rs 10 lakh insurance amount to the deceased's mother with 8% interest, Rs 1 lakh compensation for causing harassment and Rs 10,000 extra towards legal expenditure.
This story originally appeared on: India Times - Author:Tax Cognition
