The District Consumer Disputes Redressal Commission-I, U.T. Chandigarh bench, consisting of Pawanjit Singh (President) and Surjeet Kaur (Member), recently ruled in favor of the complainant in a case against Kotak Mahindra Life Insurance Company Ltd. The commission found the insurance company liable for deficiency in services for repudiating a genuine claim filed by the complainant.
Background of the Case
Mr. Pardeep Garg had obtained a home loan of ₹ 77,40,000/- from L&T Housing Finance Limited and mortgaged his only residential house due to financial distress. In June-July 2019, the marketing and sales manager of L&T, Rajesh Kushwaha, convinced Mr. Garg to secure the loan by obtaining insurance from Kotak Mahindra Life Insurance Company Ltd. Despite disclosing his kidney disease, Mr. Garg was assured by the sales manager that it would not affect the policy benefits. However, in October 2020, Mr. Garg, the Deceased Life Assured (DLA), passed away after contracting COVID-19. Mrs. Rajni Garg, the complainant, sought policy benefits, but the insurance company rejected the claim, alleging that the DLA had concealed his kidney disease. The complainant approached the District Consumer Disputes Redressal Commission-I, U.T. Chandigarh and filed a consumer complaint against the insurance company, its sales manager, and L&T.
Arguments Presented
The insurance company contended that the DLA had concealed his kidney disease in the medical questionnaire, justifying the rejection of the claim. The sales manager denied any cause of action against him and requested the rejection of the complaint. L&T argued that if an insurance claim is payable, it should be paid by the insurance company, not them.
Findings of the District Commission
The District Commission found no merit in the insurance company’s repudiation ground based on the alleged concealment of kidney disease by the DLA. It held that the insurance company failed to produce evidence showing that the insured still suffered from the alleged disease and neglected to obtain information from the hospital about the basis of the recorded history. Additionally, the District Commission determined that even if the DLA had kidney disease, it had no connection to the cause of death, which was ischaemic heart disease and myocardial infarction. The medical certificate of cause of death specified hypoxic cardiac arrest and COVID-19 pneumonia sepsis. Therefore, the District Commission concluded that the insurance company’s repudiation was unjustified and held it liable for deficiency in services.
Decision and Compensation
Based on its findings, the District Commission directed Kotak Mahindra Life Insurance Company Ltd. to pay the claim amount of ₹ 79,90,953/- to the complainant, along with interest. The insurance company was also ordered to pay a compensation of ₹ 20,000/- for the mental agony caused to the complainant and litigation costs of ₹ 10,000/-.
