Noida Consumer Commission Holds Care Health Insurance Guilty of Service Deficiency
The District Consumer Disputes Redressal Commission in Noida has delivered a significant verdict, finding Religare Health Insurance, now operating as Care Health Insurance under Religare Enterprises Limited, guilty of deficiency in service. The ruling comes in response to the company's wrongful rejection of an accidental death insurance claim filed by a woman whose husband tragically died from electrocution in 2018.
Commission Directs Full Claim Payment with Interest and Compensation
On March 5, the commission, presided over by President Anil Kumar Pundir and member Anju Sharma, issued a decisive order. The insurer has been instructed to pay the full claim amount of Rs 10 lakh to the complainant. Additionally, the company must pay 6% interest per annum calculated from the date the claim application was originally filed in 2019. As further penalty, the commission has mandated a compensation payment of Rs 5,000 to the aggrieved policyholder.
The commission strongly criticized the insurance company's handling of the case, stating that insisting on a police report and autopsy for a domestic electrocution death was unreasonable and constituted a clear service failure.
Background of the Insurance Claim Dispute
The case was initiated by Babita Devi, a resident of Salarpur Khadar, who approached the consumer commission after Care Health Insurance rejected her claim for accidental death benefits. Her husband, Krishna Kumar Tiwary, was employed by Jaguar Security Services Pvt Ltd and was covered under a group secure insurance policy provided by Religare Health Insurance.
"According to the policy terms, if the insured dies in an accident, the company is obligated to pay an accidental death claim of Rs 10 lakh to a family member," Babita Devi explained to the commission. She detailed that on July 23, 2018, her husband suffered a severe electric shock at their home and succumbed to his injuries during treatment the same day.
Babita Devi formally applied for the insurance claim on October 11, 2018, but received a rejection notice citing incomplete documentation. She informed the commission that the insurance company had demanded an FIR, post-mortem report, and police investigation report—requirements she argued were unnecessary since the accident occurred domestically and did not involve any criminal circumstances warranting police intervention.
Insurance Company's Defense and Commission's Rejection
In their defense, Care Health Insurance filed a counterclaim denying any service deficiency and asserting that the complaint was based on unsubstantiated facts. The company's legal counsel challenged the commission's jurisdiction to hear the case, arguing that an insurance ombudsman established by the Insurance Regulatory and Development Authority should handle such disputes.
The insurance company acknowledged that Tiwary was indeed covered under a group policy issued to Jaguar Security Service Pvt Ltd. Their representatives stated, "The complainant submitted a claim on July 23, 2018, for treatment at Prayag Hospital, Noida, following the accidental electric shock. After receiving the claim, our company sent multiple letters dated August 26, 2019, September 5, 2019, and November 30, 2019, requesting specific documents. Despite several reminders, the complainant failed to provide the necessary documentation and information, leading to the claim's closure."
They further revealed that another claim for reimbursement following the policyholder's death had been submitted and rejected as early as December 15, 2018.
Commission's Final Determination and Rationale
After thorough consideration of all arguments and evidence, the Noida District Consumer Commission concluded that the insurance company's demands for police documentation were unjustified given the nature of the accident. The commission determined that the complaint clearly established that the husband's death resulted from a domestic accident that did not require police action or investigation.
This ruling emphasizes the consumer protection framework's role in ensuring insurance companies fulfill their contractual obligations without imposing unreasonable documentation requirements on claimants during times of personal tragedy.
