The commission ruled that a reporting delay could not defeat a claim supported by medical and police records, and ordered the insurer to pay the policy benefit, compensation and legal costs.
A consumer commission in Tumakuru has ordered United India Insurance Company to pay Rs 2 lakh to a man whose wife died after a road accident, saying the insurer could not rely on a filing delay to defeat a claim that was otherwise substantiated by the record. The commission also awarded Rs 10,000 in compensation and Rs 8,000 in legal costs, and directed interest at 9 per cent a year from the date the claim was rejected.
According to the complaint, S Mahesh’s wife, Manjula, was riding as a pillion passenger on 25 December 2023 when the motorcycle she was on fell after an oncoming vehicle switched on its headlights near Podar School at Maralur Tank Bund in Gulur village, in Tumakuru district. She suffered severe head injuries and fractures, was taken first to Tumakuru district government hospital, then referred to NIMHANS in Bengaluru and later KC General Hospital, before dying on 29 December 2023. A postmortem attributed her death to injuries from the road accident, and the commission said the medical and police papers supported that conclusion.
Manjula had enrolled in the Pradhan Mantri Suraksha Bima Yojana through Karnataka Gramin Bank’s Urdigere branch and had paid the annual premium of Rs 20 on 26 September 2023. The government says PMSBY is a one-year personal accident scheme for eligible bank account holders aged 18 to 70, with Rs 2 lakh payable for accidental death or permanent total disability and Rs 1 lakh for partial disability. Mahesh said he filed the police complaint on 3 January 2024 and submitted the insurance claim through the bank on 9 February 2024, after which United India Insurance rejected the case on the ground that notice and documents had not been sent within the policy deadlines.
In its 5 October order, the Tumakuru District Consumer Disputes Redressal Commission said the insurer and the bank had not shown that Manjula or her nominee had been clearly told about the reporting conditions. Relying on Supreme Court rulings that caution against mechanically dismissing genuine claims because of delay, the commission said a procedural lapse should not override a claim that is otherwise proved in good faith. It found no fault with the bank, which it said had forwarded the paperwork, but held that the insurer’s refusal amounted to deficiency in service.
The ruling fits a wider line of Supreme Court decisions that have warned insurers against using notice clauses as a technical shield when the underlying claim is genuine and the delay is reasonably explained. At the same time, those decisions do not remove policy conditions altogether; rather, they require insurers to look at the substance of the claim, the surrounding circumstances and the available evidence before deciding whether to pay.
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