Ahmedabad Ombudsman Centre
Case No. 11 / 012 / 0177
Smt. Ugamben R. Pansal
Vs.
ICICI Lombard General Ins. Co. Ltd.
Husband of the Complainant was covered under Shramik Suraksha Yojana, a Group Insurance Scheme for the Landless Agricultural Labourers of Gujarat. On his death by an accident, wife lodged a Claim, but repudiated due to non-compliance of certain requirements such as Police Report, Post – mortem Report and Medical Report by the Complainant. Based on materials on record, the main point examined in this case is that why the Complainant failed to submit the aforesaid documents and was it a genuine Claim and if so, can it be considered admissible.
It is observed that Respondent had conducted an investigation through a Private Detective, who in turn submitted their Report stating that the death of LA was caused by an Accident. They further confirmed in their Report that neither FIR was lodged nor Post-mortem was undertaken. Further, observed that the Claim Form submitted by the Complainant had been authenticated by the Rural Labour Officer. As the Scheme is desired and designed to benefit the underprivileged and unorganised segment of rural population in conformity with the IRDA Regulations 2002, non-payment of Claim giving priority to certain formal requirements will definitely defeat the sole purpose of the Scheme. Genuineness of the Claim is established beyond doubt through investigation. Respondent to pay Rs. 20,000/- to the Complainant.
