Kathmandu. The Insurance Authority of Nepal (IA) has set a precedent that a life insurance company cannot reject the claim of life insurance on the assumption that the insured person has contracted the disease due to the consumption of alcohol.
Alka Devi Agrawal, who was insured with Asian Life Insurance for a period of 20 years, passed away 10 months and 4 days after the insurance policy was issued. He died while undergoing treatment at Mediciti Hospital on January 9, 2020. Petitioner Rohit Agrawal had filed the complaint on November 23, 2021.
The insurance company rejected the claim claiming that the insured had falsely declared that he had no health problem in the insurance proposal form and that he had died due to liver disease due to alcohol consumption in the documents of Medicity Hospital, where the insured was suffering from liver disease due to alcohol consumption and was taking medicines for asthma.
Mention of Insurance
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The insurance did not submit an outpatient certificate to the claimant regarding the treatment OF the insured and in the abbreviation OF the treatment OF the insured, it is mentioned as Alcoholic Liver Disease with signs of PORTAL HTN, COPD UNDER MEDICATION, RECURENT-UTI / disease and in the death certificate, it is mentioned CIRRHOSIS OF LIVER WITH ASCITES WITH PORTAL HYPERTENSION GASTROPATHY / CHRONIC OBSTRUCTIVE PULMONARY DISEASE. It was also argued that the death claim amount should not be paid as the life insurance had acted against the principle of good faith by making false declaration in the insurance proposal form.
The insured had declared in her personal health statement that she had no liver disease and that she did not drink alcohol. Her insurance agent Maya Devi Kapraula had also stated in the agent report that she already knew the insured and was a neighbour of the insured.
Authority
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Regarding the decision of the insured Alka Devi Agrawal to submit all the documents from the treatment of the insured Alkadevi Agrawal to Nepal Mediciti Hospital Lalitpur on January 14, 2080 regarding the decision of the insured Alka Devi Agrawal to submit all the documents from the treatment of the insured Alkadevi Agrawal to the insurance company regarding the decision of the insured Alka Devi Agrawal on January 16, 2020 regarding the decision of the insured that she died due to serious liver disease and asthma due to alcohol consumption. In the documents submitted along with the letter, it appears that the treatment of the insured has been done after the commencement date of the insurance on March 22, 2019. It is not mentioned in the medical documents that he had been treated for excessive drinking and asthma from the previous date of his insurance.
On the other hand, in the brief treatment report of Nepal Mediciti Hospital dated January 5, 2021, it is mentioned that he has been suffering from liver disease due to alcohol and has been providing asthma medicines, but it is not mentioned that he had such diseases prior to the commencement date of the insurance on March 6, 2019 and since alcohol consumption is a kind of habit, it cannot be ruled out that such habit can develop even after the insurance. Therefore, the contention of the insured that the insured acted contrary to the principle of good faith could not be agreed with the present claim that the insured had not declared the disease before the insurance was insured and the fact that he died due to the same disease could not be proved.
Therefore, in view of the liability of the insured towards the death claim of the insured, the insurer has been ordered to pay the compensation amount as per the insurance policy in accordance with clause (d) of sub-section (3) of Section 128 of the Insurance Act, 2079.
