While upholding the orders of the Wafaqi Mohtasib to pay life insurance claim to the widow of a policyholder, President Dr Arif Alvi conveyed his displeasure to State Life Insurance Corporation of Pakistan (SLICP) for denying legitimate insurance claim settlement to a widow for 9 long years. While expressing his displeasure on maladministration by SLICP, the President ordered that the widow be paid full amount of claim with accumulated profit by factoring in inflation during the waiting period. The President rejected the representation preferred by SLICP against the Wafaqi Mohtasib’s (WM) order directing it to settle the claim by providing due relief to the widow according to the policy provisions within 30 days of the orders. The President observed that the point of view of SLICP was not tenable as the insurer was declared medically fit in the medial examination of the deceased conducted by the authorized medical officer of the Agency prior to the issuance of the policy. He observed that SLICP had all the means of discovering the alleged pre-insurance ailment by exercising due diligence through the authorized medical officer before issuance of the policy. The President held that the onus to prove the pre-insurance ailment rested upon SLICP, and the repudiation of the claim required unimpeachable evidence regarding the existence of the alleged ailment. He said that the Confidential Report of the Field Officer of SLICP had declared the insured as healthy at the time of the issuance of the policy and categorically stated that he knew the deceased policyholder, thus, the plea of the pre-insurance ailment was hit by the principle of estoppel. The President declared that in view of the facts of the case, maladministration stood established on part of SLICP, therefore, the representation against the orders of WM was rejected. The deceased, Malik Dilshad, had purchased a life insurance policy from SLICP on 30.11.2010 for the sum assured of Rs 200,000. He died on 21.07.2013 and his wife Mst Shabnam Dilshad (the complainant) applied for the insurance claim to SLICP, which was repudiated on the ground that the deceased policyholder had pre-insurance ailment of heart disease, which he had hidden. Feeling aggrieved, she approached the Wafaqi Mohtasib, which passed the order in her favour. SLICP, then, filed a representation against the orders of WM.
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