Thane District Consumer Rederessal Forum president Sneha Mhatre and member Madhuri Vishwarupe said the insurance firm was deficient in services as it rejected the claim citing wrong reasons, due to which the claimant had to undergo mental torture.
The claimant, Achala Marde, told the forum that her husband Rudranivas Marde used to work with a company at Boisar in the neighbouring Palghar district.
On December 24, 2009, he was on his motorcycle when another two-wheeler, coming from the opposite direction, collided with his vehicle on the Tarapur-Boisar road.
The man sustained severe injuries and died the next day while undergoing treatment at a hospital.
Following the man's death, his wife filed a claim of Rs 7.5 lakh with the United India Insurance Company Ltd, since her husband had taken the policy with it.
The insurance company rejected the claim citing the man's medical examination report, which said he was under the influence of ethyl alcohol at the time of the accident.
The insurer said its policy form had a column asking if the deceased was under the influence of drugs or drinks (liquor) at the time of the accident.
The claimant had stated 'No' in the said column, which was a misrepresentation/suppression of the fact. Hence, the claim stands repudiated, the insurance firm said.
The claimant informed the forum that her husband was a man of religious nature and had never consumed liquor.
According to the claimant, her husband was taken to hospital immediately after the accident and the medicines given to him contained a certain amount of ethyl alcohol, which was reflected in the medical report.
Hence, it cannot be concluded that he had consumed liquor, she said.
The claimant's counsel, citing various judgements of other courts regarding similar cases, said the insurer wanted to take benefit of the post-mortem report and the exclusion clause in the policy, which was unjustified.
There was a deficiency in services by the insurer which needed to be compensated and the claim settled, the counsel said.
After hearing both the sides, the forum last week directed the insurer to pay the Rs 7,87,500 (including the sum claimed and the cumulative bonus on the policy) along with six per cent interest per annum from the date of filing the claim in February 2011.
Disposing of another claim in connection with the same accident, the forum directed the insurer to pay the woman Rs 1 lakh personal accident insurance claim, Rs 8,932 as the charges of repair of the two-wheeler, Rs 20,000 towards mental sufferings and Rs 10,000 for the legal expenses.