Insurance Claim cannot be rejected due to non submission of postmortem report

Case No: CHD-G-049-1516-0640
In the matter of Mr Sonu Kumar

Vs

New India Assurance Company Ltd

Insurance Ombudsman Date of award- 14.03.2016

GPA Policy


FACTS:
Mr Sonu Kumar complained to this office on 18.11.2015 stating that his father Mr. Chuhar Ram was an account holder of Corporation Bank. The Bank had taken a Group Personal Accident Policy for its accounts holders from New India Assurance Company for a sum insured of Rs.5,00,000/- each. His father was electrocuted while sitting in his shop as high tension cable running over head snapped and fell on him. He was taken to the Hospitals but did not survive. The accident was reported to the Police. The body was cremated without postmortem with the approval of the Civil/ Police Authorities. The Personal Accident claim of the deceased was denied on the grounds that no post-mortem was conducted.

FINDINGS: It was observed that that Mr Chuhar Ram while working in his Jhughi (hut) on 11.05.2015 was electrocuted as overhead 11000 V electricity cable broke and fell on him. He suffered electric shock and was taken to Civil Hospital Banur and from there he was referred to Gian Sagar Hospital. On examination of Mr Chuhar Ram by the doctors at Gian Sagar Hospital, he was declared dead. Necessary Police report was also lodged. It is also recorded in the Police Report that “Request was made by the family and close friends of the deceased that they do not want a postmortem done as the cause of death is obvious. Police asked them to approach Sub Divisional Magistrate (SDM) who is competent authority to waive off the postmortem. An application was submitted by the son of the deceased to SDM, which was returned with the remarks that concerned Police Authorities may decide at their own level subject to Police Rules. Subsequently Station House Officer allowed the body to be cremated without postmortem”

DECISION: On the basis of evidence on record it was established that Mr Chuhar Ram was electrocuted and died due to this accident. Postmortem was waived by the Competent Authority as per Law. Sequences of events and subsequent developments have not been rebutted by the Insurer. Therefore, denial of claim due to non-submission of postmortem was held to be against the spirit of the policy terms and conditions. Accordingly New India Assurance Company Limited was directed to settle the claim and make payment to the legal heirs/ nominee of Shri Chuhar Ram.