MUMBAI: The Bombay high court has directed Tata AIG General Insurance to pay Rs 27 lakh with interest as awarded by the insurance ombudsman to a widow within four weeks. The insurance had come with a housing loan taken by the woman’s husband.“The very objective of availing the insurance policy was to secure repayment of loan in the event of death or incapacitation of the borrower … . However, this noble objective is completely frustrated on account of the actions of the petitioner-insurance company. It has attempted to wriggle out of the obligation to disburse the claim amount … ,” said Justice Sandeep Marne on Sept 3 while dismissing Tata AIG’s appeal.In June 2017, India Infoline Housing Finance Ltd (IIFL) sanctioned Rs 27 lakh with a compulsory condition to avail insurance policy. On April 15, 2021, her husband suffered severe cardiac arrest in hospital and passed away within 15 to 20 minutes. In Oct 2021, her claim was repudiated citing absence of medical documents to substantiate death due to any critical illness as specified and defined under the insurance policy. In Nov 2021, the widow submitted a letter from the treating doctor that her husband suffered a heart attack. In Nov 2022 the ombudsman directed Tata AIG to pay the entire Rs 27 lakh. The widow’s advocate said ILFL took symbolic possession of the flat for non-repayment of loan. Tata AIG’s advocate said its panel doctor examined the case papers and opined that treatment was given for infection and Covid-19 and not heart attack.Justice Marne said the treating doctor explained death was caused within a few minutes of the insured complaining of chest pain, leaving no time for any diagnostic investigations. The ombudsman held that breathlessness and chest pain were symptoms of heart attack and therefore the claim was admissible. Justice Marne said even if it is believed the insured was treated for Covid and sepsis infection, “it was not impossible for the insured to suffer a cardiac arrest”. Therefore, the “first-hand” opinion of the doctor “who actually treated the insured cannot be ignored altogether” and the panel doctor’s report, based “merely on perusal of papers”, “cannot be blindly accepted”.Justice Marne refused to interfere with the ombudsman’s order. He said HC would have been justified in imposing costs on TATA AIG for making the widow litigate “for the last four long years”. However, the ombudsman had already awarded interest at applicable bank rate plus 2% from the date of rejecting the claim till date of payment.
