The insurance companies reserve the right to refuse a claim if they find valid reasons. They can only do this for the first three years of the policy. In the event of renewal of the policies, the three-year clause will take effect from the date of renewal and not from the date of issue.
However, the Life Insurance Corporation (LIC), in one case, denied accident insurance coverage because the policyholder, who died of drowning, was under the influence of alcohol at the time of the accident. deaths, reported The Financial Express.
After the plaintiff, the insured’s father, approached the National Consumer Dispute Resolution Commission (NCDRC), the order was however reserved.
The policyholder had taken out the LIC Jeevan Anand policy with benefits and accident benefits. The risk covered was Rs 4,70,000. The report added that this included Rs 2.35,000 as sum insured and Rs 2.35,000 as Accident Benefits.
After the death of the insured on June 8, 2014, the insurance company refused to pay accidental coverage on the grounds that the insured was under the influence of alcohol at the time of death, which constituted a violation of the policy conditions, according to the report. .
According to the report, the claimant’s father approached the district forum, where the order was reversed, stating that there was no conclusive evidence to suggest the death was under the influence of the alcohol.
Although the forensic laboratory report showed the presence of 59.45 mg of ethyl alcohol in the insured’s blood, the forum stated that no urine sample was taken during the investigation. autopsy.
The insurer challenged the order in the state forum, where it was settled in their favor before the plaintiff finally approached the NCDRC.
In its order dated September 14, 2022, the commission noted that there was no evidence to prove that “the contents of the stomach smelled like alcohol and whether blood and urine samples from the deceased had been taken or not,” the report said.