The Navsari Consumer Disputes Redressal Commission (CDRC) has directed an insurance company to pay a Rs 15 lakh claim that was earlier repudiated due to the absence of a postmortem report. The case involved a resident of Navsari who died five months after a two-wheeler accident. The deceased had a personal accident (PA) cover of Rs 15 lakh, but the insurer rejected the claim filed by the family. The CDRC observed that the insurance company failed to prove that a postmortem report is mandatory for a claim under the PA cover.
Background of the Case
Ramesh Patel had a two-wheeler policy from IFFCO-Tokio General Insurance for the year starting November 14, 2021, with a Rs 15 lakh PA cover for the owner/driver. On May 8, 2022, he met with an accident and sustained severe head injuries. After undergoing treatment at various hospitals, he died at his home on October 20, 2022. Following his death, the family filed a claim for the Rs 15 lakh PA cover and submitted required documents such as the FIR and panchnama.
Insurer's Denial and Family's Complaint
The insurance company demanded a postmortem report and inquest panchnama and subsequently refused the claim. Consequently, the widow and son of the deceased filed a complaint with the Navsari CDRC on August 5, 2025. During the hearing, the insurer's advocate argued that the claim had not been repudiated but closed. The applicant had failed to provide the postmortem report and documents pertaining to the medico-legal case, among others. Therefore, the complaint ought to be treated as premature and rejected in view of the policy conditions.
CDRC's Observations and Ruling
After hearing both sides, the consumer forum refused to accept the insurance company's arguments. The CDRC observed: "After the accident, an FIR was filed with Navsari Rural police station. Police also visited the place of accident and filed a panchnama for it. This proves that the death had taken place due to an accident. As the company had asked for a postmortem report, the complainant had made it clear that after prolonged treatment at various hospitals, the victim had died at home. Thus no postmortem was done. The company had failed to prove that a postmortem is compulsory for a person who has died due to an accident under the Insurance Act and related laws."
Based on these observations, the Navsari CDRC ordered the insurance company to pay Rs 15 lakh with 9 percent interest to the family of the victim. Additionally, the company was directed to pay Rs 25,000 for the harassment and expenses caused to the claimants.
