This case revolves around a complaint from a resident of Veppampattu near Tiruvallur. The railway station in the area has no foot over the bridge, which compels people to cross the railway line to carry out their daily activities. Unfortunately, the complainant’s husband met with an accident while crossing the railway line on 4th May 2022 and passed away. The complainant submitted a claim to the insurer, which was rejected because the insured was involved in an unlawful act.
You might notice that insurance companies deny the claim instantly whenever there is a usual circumstance. The same thing happened here with the insured, as crossing the railway line differs from what we usually do daily and meet with an accident. However, the complainant argued that there was no other way to access essential services in the area. She also highlighted that there was no foot-over bridge in the vicinity, which forced people to cross the railway line. Finally, the complainant contended that the insurer should have considered the accident’s circumstances.
However, Insurance Samadhan knows best what to do in these situations and offers expert advice to the people. When the complainants contacted us, we accepted the case knowing that the insured deserved to challenge the insurer given the circumstances. Insurance Samadhan contended that the insurer’s decision to deny the claim solely on the grounds of the insured’s alleged unlawful act was unfair and arbitrary. Insurance Samadhan urged the insurer to reconsider the claim and consider the accident’s circumstances. Thus, the complaint is allowed.
With persistence and determination, Insurance Samadhan secured a favorable decision for the complainant. Finally, the insurer agreed to settle the claim and compensate the complainant for losing her husband. This case underscores the importance of seeking help from consumer complaint resolution platforms like Insurance Samadhan, which can challenge the insurers’ decisions and fight for the rights of consumers. The forum directed the insurer to settle the claim for INR 27,50,000 as per policy terms and conditions.
The decision in favor of the insured has motivated many people to fight for their rights. One thing to learn here is that every situation and every case is different and we should not feel defeated without a fight.
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