Lack Of Evidence For Cause Of Death, Kannur District Commission Dismisses Complaint Against New India Assurance Co.

Brief Facts:

The deceased insured was covered under a personal accident coverage policy with New India Assurance Co. Ltd. (“Insurance Company”). During the subsistence of the policy, the deceased sustained severe injuries in an accident which led to his demise. The police registered the incident and conducted a postmortem which concluded that the cause of death was not an accident but a heart attack.

Meanwhile, the nominees of the policy (“Complainants”) submitted a claim with the Insurance Company. They argued that while the postmortem findings attributed the death to a heart attack, the injuries from the accident contributed significantly to the insured's demise. However, the Insurance Company repudiated the accidental claim. Feeling aggrieved, the Complainants filed a consumer complaint in the District Consumer Disputes Redressal Commission, Kannur, Kerala (“District Commission”).

The Insurance Company contended that the death was solely due to a heart attack and not related to accidental injuries. It claimed that the Complainants failed to inform it promptly or submit necessary documents.

Observations by the District Commission:

The District Commission examined the postmortem report and held that the cause of death of the insured was attributed to a heart attack. Despite the Complainants presenting testimony from the doctor who conducted the autopsy, the District Commission held that there was no conclusive evidence linking the insured's death to the injuries sustained in the road accident. Furthermore, the District Commission held that the police investigation did not establish the incident as a road traffic accident.

Therefore, the District Commission held that the Complainants failed to substantiate their claim that the insured died as a result of injuries sustained in a road traffic accident. The absence of clear evidence connecting the insured's death to the accident injuries led to the District Commission's determination that the rejection of the claim application by the Insurance Company was justified.

Consequently, the District Commission dismissed the consumer complaint against the Insurance Company.

Case Title: Thulasi Shajan and Ors. vs The New India Assurance Company Limited

Case Number: CC/314/2021

Date of Order: 30.05.2024