A bench of VP Utpat and Onkar G Patil at Pune district consumer court has directed HDFC Ergo General Insurance Company Limited, Koregaon Park, to pay Rs 1 lakh claim amount, along with 9 per cent p.a. interest since February 11, 2015, and Rs 10,000 costs, to a woman for rejecting her claim over the death of her husband, citing 'flimsy reason'. The company had argued that her husband could not survive for 30 days after being diagnosed with critical illness.
Tanaji Bajirao Dudhale, a resident of Rajgurunagar in Khed taluka, had purchased a 'sarva suraksha star insurance policy' from HDFC Ergo on February 10, 2012. The policy was valid from February 10, 2012, to February 9, 2015, and as per terms and conditions, the company had agreed to pay Rs 1 lakh if the insured suffered from a critical illness. On December 26, 2014, Dudhale died at a private hospital in Chinchwad due to acute myeloid leukemia, leaving behind his wife, Urmila, and three minor children. He was the sole bread earner in the family.
HDFC Ergo rejected Urmila's plea for Rs 1 lakh compensation. The company did not dispute the validity of the insurance policy and the critical illness suffered by the insured, but had argued that for the critical illness to be admissible under the policy, the insured person had to survive a period of 30 days from the time he was diagnosed for such illness.
The bench observed: “It is significant to note that birth and death of anybody is not in the hands of any person. In such circumstances, insurance company cannot put such stringent and absurd condition in the policy. It is expected that terms and conditions of the policy are always approved by Insurance Regulatory and Development Authority (IRDA). However, such condition, which is against the public policy and against the rule of mortality, cannot be put. Hence, that condition is void ab initio and it should be ignored.”
The bench slammed the general tendency among insurance companies to repudiate legitimate claims and described the same as a “pitiable condition” for poor people who fall prey to the rosy picture created by insurance firms while attracting clients. “In certain cases, insurance company should not contest the claim when the claim appears to be legitimate,” the bench said.