Nashik: The local consumer forum has ordered an insurance company to settle a claim for Rs 15.95 lakh of a widow whose husband was a policy holder, saying that pre-policy medical check-up report was “the key for knowledge pre-existing diseases”.Suvarna Tushar Kharote (40) had registered a complaint against HDFC Ergo Insurance Co Ltd on March 27, 2017 alleging that the firm had wrongly rejected her insurance claim after the death of her husband.“My husband had insured our house in Home Security Plus scheme of HDFC Ergo from January 2016 to 2021, in which even his life was also covered. He passed away on October 1, 2016, following which I applied for the insurance claim of Rs 15.95 lakh. The company, however, was rejected the claim, saying that pre-existing illnesses was not disclosed,” said the widow in her complaint.As per the Home Security Plus insurance scheme, which was sought from 2017 to 2021 after payment of premium of Rs 94,865, the house was insured against fire, earthquake and terror attack. In the event of any such eventuality, the beneficiary was to get Rs 19.94 lakh. Also, in case of house break-in or theft, Rs 3.98 lakh was to be paid by the firm. If the insured person was diagnosed with terminal illness or died, the next of kin were entitled to Rs 15.95 lakh.The company on January 3, 2017 rejected the claim under the pretext that the insured had not disclosed the pre-existing disease at the time of underwriting insurance.The insurance company claimed that it had not violated any terms and conditions, given that it had learnt about the fact that the insured person was suffering from hypertension for more than four years before being insured.“The family doctor of the deceased had issued a certificate that he was suffering from hypertension,” the company claimed and presented the certificate to the consumer forum.The forum did not rely on the same, saying that the certificate was issued on November 11, 2016 (about a month after the death of the insured). The forum also ordered the company on November 2, 2017 to present the pre-policy medical health check-up certificate to know if the disease was revealed in the same.“The company has failed to provide pre-policy medical health check-up report despite having been given enough. The report holds the truth of the facts. We are forced to believe that the company has produced the certificate of family doctor at a later stage, instead of the report, just to ensure it does not have to pay the insurance claim to the beneficiary,” the order, signed by forum president Milind Sonawane and members Prerna Kalunkhe-Kulkarni and Sachin Shimpi said.The forum ordered the company to settle the claim of Rs 15.95 lakh in favour of the beneficiary and also pay 10% per annum interest from the date of rejection of the claim.The company will also have to pay Rs 10,000 for mental harassment and Rs 5,000 for costs incurred by the complainant.

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