Surat: The Navsari district consumer disputes redressal commission (CDRC) directed an insurance company to pay Rs 2.24 crore, with 7% annual interest, to the mother of an NRI doctor who died of a brain haemorrhage after a fall in 2024.The commission criticised the insurer for rejecting the claim contending that the doctor had failed to disclose a pre-existing liver ailment, observing that it had neither produced conclusive evidence of the condition nor established any link between it and his death.The order was passed on Aug 31, on a complaint filed by Kalpana Desai, mother and nominee of Dr Satyen Desai, who practised in the US. Dr Desai bought the policy on Nov 29, 2022, and paid an annual premium of around Rs 20.90 lakh.On May 15, 2024, he suffered a serious head injury after falling at his home. At INS Hospital, he was diagnosed with intracranial and intraventricular haemorrhage, with cirrhosis of the liver mentioned as a comorbidity/risk factor. He died during treatment on May 19.The insurer rejected the claim in Nov 2024, holding that Dr Desai had failed to disclose the liver condition. It relied on an investigation report which indicated that he had undergone a liver-related blood test in April 2022. The insurer also claimed that he had died of a heart attack caused by liver disease.The company questioned why an NRI practising in the US had bought a policy in India and raised doubts over his mother being the nominee, as his other family members lived in the US.The complainant’s advocate, Nayan Vakil, argued that medical records clearly attributed the death to the brain haemorrhage caused by the fall. He said no documents established a pre-existing liver disease or link between such a condition and the haemorrhage.After hearing both sides, the CDRC observed that the insurer had failed to produce a laboratory report conclusively establishing pre-existing liver disease or any expert opinion linking it to the death. The medical records, it said, showed that the death resulted from the haemorrhage following the head injury.The commission also rejected the insurer’s objections regarding the policy and nomination. It noted that Dr Desai had disclosed his NRI status in the proposal form and was free to nominate anyone. It further observed that for applicants older than 40 seeking cover of more than Rs 50 lakh, insurers conduct medical examinations, but the company had failed to produce the relevant medical reports.Taking note of the death summary, which did not cite liver disease as the cause of death, the commission concluded that the insurer had misinterpreted the medical facts to avoid paying the claim and directed it to pay Rs 2.24 crore with 7% annual interest.
