Kathmandu. The Insurance Authority of Nepal (ANI) has annulled the decision of the Asian Life Insurance Company (IA) to stop the payment of the death claim.
The NEA has ordered the insured amount of Rs 50 lakhs to Ruvisha Timilsina, the successor of Shiva Prasad Timilsina, to pay the insured amount of Rs 50 lakhs. Shiva had taken life insurance of Rs 5 million on January 15, 2018. He died on July 4, 2022 after 3 years and 5 months of insurance. The company had refused to pay the claim after the victim’s daughter Rubishal filed an application claim, claiming that the insured had concealed the disease.
The company had claimed that the insured had been drinking alcohol for 15 years, concealing the fact that he had liver disease and diabetes before taking the insurance. The company had decided to pay only Rs 2,200 as the surrender price of the insurance policy instead of filing the death claim.
After the insurance company refused to pay the claim, the insured’s daughter Rubeshal lodged a complaint with the authority on March 3, 2022. She filed an application with the NRA seeking an investigation into the claim dispute and to pay the claim amount.
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The Insurance Authority had asked for all the documents related to the treatment of the insured from Nepalgunj Medical College and Teaching Hospital, Maharajgunj. The Board of Directors of the Authority has decided in favor of the family members of the insured on the basis of the following facts, evidences and evidence found during the study:
Lack of Evidence The company could not produce any old medical reports or documents to prove that the insured was suffering from diabetes or hypertension and was taking medication before insuring.
{{TAG_CLOSE_span_23 TAG_OPEN_span_23}} Post-insurance disease: The authority has found that there is no evidence to show that the cause of death of the insured was a heart attack due to cardiopulmonary arrest due to UGI i.e. excessive bleeding in the upper part of the digestive tract.
The insured died after 3 years and 5 months of the insured and the policy was in force on that date. The main responsibility of the insurer is to cover the risk within the term of the insurance and to pay the payment as per the terms and conditions in case of death of the insured.
Orders to the Authority
According to clause (d) of sub-section (3) of Section 128 of the Insurance Act, 2079, the authority ordered Asian Life Insurance to pay the compensation amount of Rs 5 million as per the policy. The verdict was delivered on September 22, 2081.
This decision has sent a message to the insurance companies that the claim of the insured cannot be denied without sufficient and solid evidence.
