Pune: The Pune District Consumer Dispute Redressal Forum has ruled against a renowned private bank's insurance company for denying a widow's claim based on her husband's pre-existing conditions instead of his COVID-19 death.
The forum has ordered the insurance company to pay ₹36.40 lakh along with a 5 per cent annual interest from the complaint filing date within 45 days. The decision also includes ₹60,000 for mental agony and complaint expenses.
Shubhangi Pradeep Sonawane, represented by advocates Gandhar Sonis and Abhishek Jagtap, filed a complaint against HDFC Life Insurance and Indostar Housing Finance companies after her husband Pradeep's insurance claim was denied.
Shubhangi's husband Pradeep, who was in the transport business, had taken a loan of ₹57 lakh in November 2020 from a finance company to expand his business.
As per the terms, he had to take an insurance policy worth ₹45.70 lakh for the loan's security from the insurance company associated with the finance company. The loan repayment period was 15 years.
Pradeep died due to COVID-19, and since Shubhangi could not afford the monthly loan installment of ₹71,000, she filed a claim with the insurance company.
However, the insurance company rejected the claim, stating that Pradeep had pre-existing conditions such as diabetes, hypertension, and epilepsy.
Consequently, Shubhangi filed a complaint with the Consumer Forum. Despite a notice from the commission, no representatives from the bank's insurance company or the finance company appeared, resulting in a unilateral decision by the forum.
The forum ruled that denying the claim based on pre-existing conditions when the death was due to a natural disaster like COVID-19 is unlawful and constitutes deficient service.
This decision will set a precedent for insurance companies denying claims for COVID-19-related deaths by citing pre-existing conditions.
There was no evidence to support the claim that Pradeep's death was due to diabetes and hypertension, highlighting the service deficiencies of the insurance company.