Kathmandu. KATHMANDU: Nepal Insurance Authority (NIA) has dismissed a complaint filed by the Insurance Authority (NIA) after it was found that the date of death was altered in the insurance scheme made for foreign employment. The authority has ruled that Surya Life Insurance (now Surya Jyoti Life) is not required to pay the claim, citing that the insured may have died before the insurance policy was issued and the documents were suspicious.
What was the event?
Jharilal Kamai, a resident of Siraha, had taken foreign employment term life insurance from Surya Life Insurance on 17th Baisakh 2076. His wife Basmatiya Devi Kamait had filed a claim claiming that he died on the same day.
Initially, the local body Sukhipur Municipality had recommended Kamait’s death on April 30, 2019. However, after it was found that the temporary insurance was issued only on the 17th, the date was later corrected and a new document was made stating that the deceased died on April 30. Due to the dispute on the same date, the then Surya Life Insurance Company refused to make the payment.
The main 4 grounds for rejecting the claim by the Authority
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The NRA has rejected the claim on the following grounds after taking into consideration the detailed study and the order of the High Court, Patan.
1. Chagakhel on the date of death: The municipality had initially made a notice and recommendation for the death on April 29 but later fixed it as 17th Baisakh. The NRA has termed the amendment of the date as baseless and unnatural.
2) Death on the day of issuance of insurance: It is claimed that the insured died while sleeping at home on the morning of Baisakh 17, even though his insurance policy was issued online on the same day. According to the NRA, the insurance in the name of a person who has already died or died on the same day has raised doubts.
3) Payment has already been taken from another company: The insured already has insurance in National Life Insurance and the death claim of Rs. 13 lakhs has been paid by that company. There is a mismatch between the documents submitted to National Life and the details submitted to Surya Life.
4. The judgment states that for lack of facts, different details about the cause of death of the insured have also been presented as to the passage of time and unconsciousness on the river bank and these details could not be substantiated by objective evidence.
Decision of the Authority
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According to clause (e) of sub-section (3) of Section 128 of the Insurance Act, 2079, the NRA has decided to dismiss the complaint filed by Basmatiya Devi Kamait. The verdict was delivered on September 1, 2081. With this decision, Surya Life Insurance will not have to pay the claim amount.
The dispute has been settled after the NRA gave its second verdict on 18 Bhadra 2081 BS in relation to the petition filed on January 6, 2020.
Lack of Insurance Information Center
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This case has exposed how regulators, insurers and even the courts are forced to be entangled for four years due to fake claims. Fraud in insurance claims has been rampant in insurance claims as there is no provision to exchange details related to claims received by insurance companies and insurance proposals in regulatory approval. On the other hand, there is no insurance information center to identify claims made on the basis of fake documents. On the one hand, the resources of the state have been wasted unnecessarily. On the other hand, insurance companies are getting entangled in unnecessary legal hassles due to fraud.
