Tata Aig General Insurance Company LTD. vs. Garima Arora

Facts

Tata AIG General Insurance Company Ltd. (Petitioner) filed a petition under Article 227 of the Constitution challenging a judgment dated 05.03.2025 by the Permanent Lok Adalat, Haridwar. The Lok Adalat allowed an application by respondent No. 1, directing the petitioner to pay outstanding dues on a housing loan account of her late husband, Rajneesh Kumar, as per an insurance policy. Rajneesh Kumar had taken a home loan of Rs. 21,00,000/- from Tata Capital Housing Finance Company Ltd. on 10.10.2018, with a "Group Credit Secure Plus" Insurance Policy issued by the petitioner, valid from 16.10.2018 to 15.10.2023, for which a premium of Rs. 80,039/- was paid. Rajneesh Kumar passed away on 25.04.2021. Respondent No. 1 submitted a claim, supported by a Death Certificate stating cardiac arrest as the cause of death. The petitioner repudiated the claim, asserting the death was due to Coronavirus, which was not covered by the policy. The Lok Adalat allowed the claim after conciliation failed.

Held

The Court held that the Permanent Lok Adalat was justified in relying on the Death Certificate issued by a Government Doctor. The petitioner's contention that an autopsy report was necessary to corroborate the death certificate was found to be without force. The Court reasoned that the petitioner failed to discharge its burden of proving that the death was not due to heart failure but due to Coronavirus. The fact that the insured tested COVID-19 positive on 17.04.2021, based on a sample collected on 15.04.2021, was not sufficient to infer death from Coronavirus, especially given the death occurred on 25.04.2021. The Court found no material on record to create doubt about the Death Certificate or to discredit the respondent's statement that her husband complained of chest pain and was declared "brought dead" at the hospital. The investigation report relied upon by the petitioner also indicated cardiac arrest as the cause of death, despite a reference to Coronavirus. The Court concluded that the petitioner did not adduce any evidence to rebut the cause of death shown in the Death Certificate or to prove suppression of facts by the insured. Therefore, the ground for repudiating the claim was unsustainable. The judgment of the Permanent Lok Adalat was not found to warrant interference under Article 227 of the Constitution.

Key Issues

1. Whether the Permanent Lok Adalat erred in relying upon the death certificate, which mentioned heart failure as the cause of death, without an autopsy report to corroborate it, as argued by the petitioner? 2. Whether the petitioner discharged its burden to prove that the death was not caused by heart failure but by Coronavirus, and that respondent No. 1 furnished incorrect information or suppressed facts, as contended by the petitioner? Petitioner's arguments: The petitioner contended that the Lok Adalat erred in relying on the death certificate without an autopsy report. They argued that the burden of proving death by heart failure was on respondent No. 1 and that her husband died of Coronavirus, which is not covered under the policy. They also stated that respondent No. 1 failed to produce relevant documents regarding her husband's treatment and that an autopsy was not performed. Respondent No. 1's arguments: Respondent No. 1 argued that the cause of death was corroborated by the Death Certificate issued by a Government Doctor. She stated her husband died before reaching the hospital and was declared "brought dead," thus no treatment could be given. She also noted that while a Coronavirus test sample was given on 15.04.2021, the report came on 17.04.2021, and death occurred on 25.04.2021, indicating a significant gap.