Fatal heart attack: Insurer to pay `24L

Mumbai: The state consumer commission has ordered ICICI Lombard to pay Rs 24 lakh to a woman who was almost evicted from her Andheri (east) home after the firm repudiated her claim for her deceased husband’s insurance amount of Rs 18 lakh on the grounds that “heart attack” was not covered under the policy. The husband had taken a housing loan of Rs 19.3 lakh in 2013 from Dewan Housing Finance Ltd (DHFL) and as a prerequisite, had to procure the insurance policy. Without the insurance amount, the woman, Nafeesa Natekar, could not pay EMIs and the financier had threatened to evict her.

Incidentally, the Natekars had additionally taken a second housing loan of around Rs 7.4 lakh from the same financier and it was covered through an insurance policy taken from Bajaj Allianz. This amount was released soon after Nafeesa submitted her claim in 2016. In her complaint, Nafeesa also named the financier, DHFL, alleging that it “illegally” forced her to deposit Rs 3.4 lakh until 2017. But the commission refused her request for a refund and said it should be adjusted against the outstanding loan amount.

Allowing Nafeesa’s complaint against ICICI Lombard, the commission held that the heart attack could have been caused by myocardial infarction (caused by inadequate blood supply to the muscles of the heart) which was among the nine major medical illnesses covered under the policy. “We are of the opinion that merely because husband of complainant (Nafeesa) died due to massive cardiac arrest, it cannot be considered that the illness by which he died is not covered under the policy. In view of the same, we are of the opinion that the repudiation of insurance claim of complainant in respect of her husband is not proper,” the commission said.

Nafeesa has submitted the complaint before the Maharashtra State Consumer Disputes Redressal Commission in 2017. She said that in respect of the insurance policy, her husband paid a premium of Rs 1.3 lakh and renewed it annually. Nafeesa said that on January 3, 2016, her husband died after suffering a massive cardiac arrest.

She further submitted that after the insurance company did not give her the policy amount, she could not pay the EMIs. Nafeesa said the financier started recovery proceedings against her under the Securitisation and Reconstruction of Financial Assets and Enforcement of Securities Interest (SARFAESI) Act. She said that through a letter dated November 17, 2016 the financier informed her that it had taken formal possession of the flat. Nafeesa said she sent a reply through her lawyer. She submitted that the financier compelled her to deposit Rs 3.4 lakh until May 31, 2017. She complained that since the insurance company repudiated her claim, she was forced to pay the deposit to the financier.

The commission directed the insurance company to pay the insurance amount of Rs 18 lakh, along with an interest of 9% from 2016. Additionally, the insurance company was also directed to pay her compensation of Rs 1.1 lakh.

Source: The Times of India