Prafull Bahadure had bought a Classic Life Plan Policy from Birla Sun Life Insurance. The policy was taken on May 19, 2011, with a half-yearly premium of Rs 15,000. Four months later, Prafull died of a heart attack. He was only 35 years old. His widow, Kiran, lodged a claim under the policy. The insurance company rejected the claim, saying its investigation had revealed Prafull was suffering from ischemic heart disease prior to giving the proposal for insurance but this was not disclosed while applying. Even the premium paid by Prafull was forfeited by the company, for allegedly making a false declaration regarding his health.
According to the complaint, Prafull had died due to cardiogenic shock and, therefore, it was a natural death. Hence, the insurance company had acted illegally in repudiating the claim on the basis of an incorrect reason. Alleging this to be a deficiency in service by the company, the complainant moved the Amravati District Consumer Forum, seeking Rs 5,40,000 towards the insurance policy amount and Rs 60,000 for physical and mental hardship.
The company dismissed the allegation. It reiterated that Prafull had a prior history of ischemic heart disease. The company claimed Prafull had been admitted to Karkraniya Hospital on February 10, 2010, but did not produce any evidence to show for what he had been admitted. The forum concluded the company had been unable to substantiate that Prafull had ischemic heart disease prior to taking the policy. Considering the evidence, the Forum allowed the complaint.
Birla Sun Life appealed to the Maharashtra State Consumer Commission. There was a delay of 56 days in filing the appeal, which the company tried to justify by claiming that unlike individuals, a corporate body functions through its officials because of which decision making takes time. The state commission rejected the argument, holding a corporate institution has wherewithal to act in a swift and speedy manner. So, the State Commission held the delay could not be condoned.
The company then approached the national commission, alleging the state commission's order was illegal, perverse, unjustified and contrary to law resulting in gross miscarriage of justice. The national commission observed the basic test for condonation of delay is to see whether a party had acted with reasonable diligence. In this case, the company had not shown sufficient cause for the delay. Hence, the national commission concluded the state commission had rightly refused to condone the delay.
The national commission nevertheless, also considered the merits of the case. The claimant had relied on the doctor's certificate, which stated 35-year-old Prafull had been his regular patient since the past 30 years. Over this period, Prafull had been treated by him for minor illness like fever and other general problems. He certified Prafull had never suffered from any major illness like hypertension, diabetes or a heart problem. The insurance company had not been able to produce any evidence to counter this.
Accordingly, by its judgment of January 31, 2015, delivered by Suresh Chandra for the Bench, along with V B Gupta, the national commission dismissed the revision petition filed by Birla Sun Life. The commission asked the company to pay the insurance amount.
The author is a consumer activist
