Kathmandu. A housewife of Biratnagar Metropolitan City Ward No. 5 was issued a life insurance policy with a sum insured of Rs 10 million on October 22, 2021.
While purchasing the policy for 10 years, his family members paid the first annual installment of around Rs 10 lakh to the insurance company, Nepal Life Insurance.
Being a big insurance company, Nepal Life accepted the offer of the insurance policy based on the opinion given by the company based on the medical examination of the trusted doctor and also issued the insurance policy. So far, everything seemed fine. It was going well.
Nepal Life Insurance Company has informed that the insured woman Hira Devi Sah died at her home on January 26, 2018. Once the insurance proposal evaluator and underwriting the insurance proposal went wrong while issuing such a large sum of insurance policy, everyone who underwrote the insurance proposal had a headache. All the documents related to the insurance proposal, the insurance proposal, the documents confirming the income source of the insured, the agent’s report, the doctor’s opinion, the laboratory report, the branch manager’s recommendation and the moral hazard report were also studied. After examining all these documents, the responsible officials of Nepal Life concluded that there was no irregularity in issuing the insurance policy.
After some time, the insured’s preferred person applied for an insurance claim. Nepal Life put it in the list of doubtful claims as it was insured with a large insured and died in a short time. And, during the investigation, it was found that the woman was suffering from a serious illness before the insurance was taken and the claim was refused.
On the basis of a letter dated Baisakh 26, 2079 from Birat Medical College, Nepal Life had rejected the insurance claim on the grounds that the insured was ill before being insured for Motor Neuron Diseases.
The insurance company has given prior consent to the insured to obtain the documents related to the treatment of the insured at the time of the proposal for life insurance. On the basis of this prior agreement, the insurance company has the right to have easy access to personal, confidential and sensitive information related to the insured’s treatment during the investigation of the claim.
Rohit Kumar Sah, the heir of the insured, had filed a complaint at the NRA on July 19, 2079 stating that he had not received the insurance claim.
The policy was issued in the name of the insured Hiradevi for a period of 10 years. He died before the time came to pay the second installment.
In the letter received by Nepal Life Insurance from Birat Medical College and Teaching Hospital on May 11, 2022, the insured woman was suffering from Motor Neurone Disease and was undergoing treatment at the hospital since October 14, 2021. The hospital informed Nepal Life through a letter that the woman had also taken 50 mg of Pox SEED medicine for the treatment.
When NEA sought information about the reason for non-payment of claim, Nepal Life Insurance had replied that the insurance claim was not payable as it acted against the principle of good faith on behalf of the insured.
Birat Medical College, Biratnagar regarding treatment of Insured Woman in the letter “This is to certify that Ms. Hira Devi Shah %%Y/F, Resident of Biratnagar-04, Morang was presented on Neurosurgery OPD on 2078/06/31 at Birat Medical College & Teaching Hospital Budhiganga-02, Morang with diagnosis of Motor Neuron Diseases. She has been treated in the same line with Tab Riluzole 50 mg POX BID was mentioned. and a test report confirming the disease.
The hospital had also provided similar details when the authority asked the medical college to provide information about the treatment of the insured. The Medical College had sent a reply to the NRA on March 28, 2080 stating that the laboratory test on motor neurone disease of Hira Devi Sah, a permanent address of Biratnagar Metropolitan City-5, had been provided on Chaitra 14, 2080.
The woman was suspected to be suffering from motor neurone disease when she went to the hospital on October 14, 2021. As soon as the doctor’s report mentioned this, the Shah family started preparing for his life insurance and purchased an insurance policy of Rs 10 million from Nepal Life. Sah’s family had to pay around Rs 1 million in insurance premiums for buying insurance policies worth Rs 10 million.
The NRA rejected the application on 18 Chaitra 2080 on the grounds that the insured had concealed the facts about the disease that he knew about before the insurance policy was issued and had insured the insurance against the principle of good faith. and ruled in favor of Nepal Life.
