ISLAMABAD: President Dr Arif Alvi has directed an insurance company to pay the death insurance claim to the widow of a deceased policy holder who was denied payment on the ground that her husband did not willfully disclose his true health condition to the company at the time of obtaining the policy.
The president gave this decision while accepting a representation filed by Shehnaz Akhtar (the complainant) against the order of the Federal Insurance Ombudsman (FIO), whereby, the case had been closed and disposed on the ground that the widow had already been refunded the premiums amounting to Rs 150,000 deducted from her late husband’s account and since the matter had been settled on compassionate grounds, thus, the company was not liable to pay the death insurance claim.
Feeling aggrieved by the decision of FIO, the complainant filed a representation with the President, which he accepted.
In his decision, the president observed that the company repudiated the claim based on the death certificate alleging that it reflected that the deceased had been suffering from diabetes mellitus and chronic liver disease since a year before death but no such period had been specified in the certificate.
He further noted that the insurance company was relying on an admission chart issued by a hospital in Lahore which pertained to the year 2017, whereas, the policy had been issued in the year 2015, thus, it did not pertain to the insurance period.
He also referred to a decision of the Lahore High Court in the year 2009, wherein it had been held that the majority of people having ailments such as hypertension, diabetes and mellitus lived either for decades or longer than people not having such diseases by remaining more careful in their lifetime, and the concealment of such diseases could not be termed as done fraudulently.
The president held that the insurance company was not justified in repudiating the insurance claim on such flimsy grounds.
He said that maladministration on the part of the insurance company had been established, therefore, the orders of the FIO were being set aside. The president further directed the company to pay the insurance claim to the complainant within 30 days of the receipt of the president’s order.
Copyright Business Recorder, 2023
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