Court Orders Insurer to Pay ₹10 Lakh Claim Without Post-Mortem

A district consumer disputes redressal commission in Mohali has mandated an insurer to honor a ₹10-lakh group accident insurance claim. The ruling stated that the lack of a post-mortem examination alone cannot justify claim denial if medical records establish a connection between the death and a road accident.

The commission directed the insurer to pay 6% annual interest from November 30, 2022, the date of claim repudiation. Additionally, ₹50,000 was awarded for compensation and litigation expenses.

The claim was filed by Raj Kumar and Kusha for their son, Akshay Kumar, who died on April 1, 2022. Akshay sustained head injuries in a road accident on March 6, 2022, and remained hospitalized until March 18. His condition worsened after discharge, leading to his death during treatment at a Mohali hospital.

The insurer had rejected the claim, citing the absence of a post-mortem and the death certificate mentioning cardiopulmonary arrest. However, the commission found that medical records continuously linked the accident, injuries, and death. Cardiopulmonary arrest was deemed the final mechanism, not the primary cause.

The commission dismissed the complaint against the employer, finding no deficiency in their service. The insurer was found to have engaged in deficiency of service by rejecting the claim solely on the lack of a post-mortem.