President Dr Arif Alvi has directed the State Life Insurance Corporation of Pakistan (SLICP) to pay the death insurance claim worth Rs 300,000 to the widow of a deceased policyholder who was denied payment on the ground that her husband’s death was not the direct consequence of road accident but he was a known patient of epilepsy. He also upheld the orders of the Wafaqi Mohtasib directing SLICP to adopt proper procedure/rules/regulations which were violated by it resulting in maladministration.
The President gave this decision while rejecting a representation filed by SLICP against the decision of the Wafaqi Mohtasib (WM). Mr Akram Masih, the late husband of Mst Rehana Bibi (the complainant), had obtained a life insurance policy from SLICP for the sum assured of Rs 300,000 for a period of 20 years. He died in a road accident and, after his death, his wife filed a death insurance claim which was rejected by SLICP claiming that he fell down due to an epilepsy attack and his death was not a direct consequence of the road accident as reflected in the FIR and was a known patient of epilepsy. Feeling aggrieved, she approached the Wafaqi Mohtasib which passed the order in her favour. SLCIP, then, filed a representation with the President against the order of WM.
In his decision, the President observed that the record showed that SLICP had not produced anything to establish that the death of the deceased was a direct consequence of epilepsy despite having all resources at its disposal. He added that the Ombudsman had rightly observed that SLICP had merely relied on Police Roznamcha without producing any corroborative evidence to support its claim.
The President further pointed out that the Confidential Report of the Field Officer of SLICP depicted that the said officer at the time of issuance of the policy had declared the insured as healthy and categorically stated therein that he knew the deceased policyholder since the last two years, thus, the plea of SLICP was hit by the principle of estoppel.
The President held that since the maladministration stood established on the part of SLICP, therefore, SLICP was directed to pay the death insurance claim to the complainant within thirty days of receipt of the President’s order and report compliance to the Wafaqi Mohtasib.
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