It appears your mother has an insurance on accident.
Then death arising out of illness like cancer .
Only in the case of life insurance having exception clause excluding few sicknesses like cancer one can get money on her death.
Insurance claim eligibility
Dear Sir, we have purchased House by taking Loan from Axis bank and have also opted for Insurance on my Mother's Name. My mother has passed away on [deleted] due to ill health(Cancer). we have approached Insurance firm to request for Claim and they say that it is not applicable as it is accidental Policy however below points doesnot specify that insurance will be applicable only in case of accidental death. SECTION - II PERSONAL ACCIDENT Subject to the terms, exclusions, definitions and conditions contained herein or endorsed or otherwise expressed hereon the Company will pay the insured as herein after mentioned. If at any time during the currency of this policy the insured’s borrower shall sustain bodily injury resulting solely and directly from accident caused by external violent and visible means, then the company shall pay to the insured or the borrower’s legal personal representative(s) as the case may be, the sum herein after set forth, that is to say: If such injury shall within Twelve (12) calendar months of its occurrence be the sole and direct cause of the death of the insured’s borrower, the Capital sum insured stated in the schedule hereto EXCLUSIONS APPLICABLE TO SECTION - II The Company shall not be liable under this Policy for: 1. Payment of compensation in respect of Death, injury or disablement of the Insured (a) from intentional self injury suicide or attempted suicide, (b) whilst under the influence of intoxication liquor or drugs, (c) whilst engaging in Aviation or Ballooning whilst mounting into, dismounting from or travelling in any Balloon or aircraft other than as a Passenger (fare paying or otherwise) in the duly Licenses Standard type of aircraft anywhere in the world, (d) directly or indirectly caused by venereal diseases or insanity, (e) arising or resulting from the Insured committing any breach of the law with criminal intent Standard type of aircraft means any aircraft duly licensed to carry passengers (for hire or otherwise) by appropriate authority irrespective of whether such an aircraft is privately owned or charted or operated by a regular airline or whether such an aircraft has a single engine or multiengine. 2. Pregnancy Exclusion clause. The insurance under this policy shall not extend to cover death resulting directly or indirectly from pregnancy or in consequence thereof. Please advise
Asked 4 years ago in Civil Law
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15 Answers
It is applicable only in respect of bodily injury caused solely by accident
2) they are not liable to pay compensation in case of Detha or insured
Its clearly mentioned "directly from accident caused by external violent" this is accident policy.
- As per rule of Insurance , Cancer is considered a natural cause of death, which comprehensive life insurance policies, such as term life or whole life.
- Further , if a person having an Accidental Death policy rather than a term or whole life policy, then it will protect that man if he pass away due to an accident , and the Insurance company will not liable to pay for for natural cause deaths such as a death from cancer, as Cancer is not considered an accidental death.
- Since, your mother was given accident policy , hence you cannot claim from the said company , as the cause of death is cancer and not accident .
Hello,
- Now, the policy is an accidental insurance policy and states that ,
"Company will pay the insured as herein after mentioned.If at any time during the currency of this policy the insured’s borrower shall sustain bodily injury resulting solely and directly from
accident caused by external violent and visible means, then the company shall pay......"
2. The clause is titled, 'PERSONAL ACCIDENT' therefore to that extent the policy covers only accidental injury or death resulting from the injury of the kind in an accident.
3. The exceptions provided in the policy documents are pertaining to accidental injury and an explanation of what does not constitute accident. One has to read the document in complete detail to find if death by ailment/natural cause is covered.
4. If the case is one that covers death then you have a case and can issue a legal notice to the insurance company demanding payment of the claim amount.
Please issue legal notice to insurance company for the compliance of the terms of the policy.
If not file suit against them to get your lawful claim through due process of law from the Court.
You need to challenge the same before consumer court and get the claim and compensation from them
This is accidental policy and dose not include natural or medical death.
Cancer death is excluded by clause d.
Dear Sir,
You are suggested to check and confirm from the policy documents as to whether the said insurance policy taken by you is eligible for the cancer disease or not. If it is applicable, then the insurance company is bound to give the claim amount and you may proceed for it by way of serving the legal notice.
Eventually under this policy you will not be compensated this is personal accident policy and the death happened because of the cancer which is not applicable in this case in case you feel that you are being cheated by the insurance company in this regard then you can file a complaint with the state consumer dispute redressal commission against insurance company if your claim is more than 20 lacs otherwise you can move your complaint to the district consumer forum and let the forum decide on the applicability of compensation in your favour
If the claim has been rejected illegally then you send them a legal notice and after sending the same you may go ahead and file a case before the consumer forum.
Regards
You are eligible.
File complaint in consumer court
From the contents you have posted here it can be understood that you have purchased an insurance police which covers death due to accident alone and not covering the death due to natural death or other nay other disease.
Therefore in my opinion, you may not be eligible for insurance claim for your mother's death which was due to illness/cancer.
Cancer is not considered an accidental death. As the name suggests, accidental death policies only.
The insurance company is right that policy was done to cover accidental death and it was a natural death due to critical illness of your mother due to cancer.
