A District Consumer Redressal Forum in Delhi on Wednesday directed Oriental Insurance to duly compensate the complainant stating that the ‘exclusion clause’ in policies cannot be held against policy holders unless it was clearly mentioned to them.
The complainant, Jagbir, had alleged that his son, who died in a road accident in 2010, held two policies with the insurance company. It was alleged that despite submitting relevant documents, the insurance company was neither paying nor denying the claim despite repeated requests.
It was also alleged that the ‘so-called terms, conditions and exclusion’ were not communicated to the policy holders and thus, the same could not be imposed on the claimants.
However, the insurance company, in its defence, argued that according to their policy, no claim will be entertained if the ‘loss information’ was received after seven days from the date of loss. They argued that the claim was made after the lapse of the seven-day period.
In their written statement, the insurance company said that they were “informed about the incident after the maximum period of seven days by the complainant.
Hence, under the terms and conditions and exclusions of the policy the claim of the complainant was held to be not payable”.
They further alleged that it was a case of suicide.
However, the court observed that the relevant documents revealed that the insured had died in a road accident.
“The post-mortem report and contents of the FIR ruled out death of the insured by suicide. Even otherwise, the opposite party has not placed on record any iota of evidence to substantiate its averment of suicide,” said the court in its order.
The consumer forum held that, “The insurance company cannot take shelter under the umbrella of terms and conditions unless the same were duly furnished to the insured.”
Referring to previous judgments, the court said, “Unless terms and condition have been supplied to the complainant before taking a policy, exclusion clause cannot be enforced.”
The court directed the insurance company to pay the complainant an amount of ₹5 lakh with an additional amount of ₹10,000 towards harassment, mental agony and litigation cost.
