Page 54 - The Insurance Times April 2025

Legal Briefs

HC orders insurer to pay damages, junks fraud runs deeper than initially thought. They say many more
agencies and institutions are involved and that from the ini-
'no valid licence' plea tial eight states from which they have nabbed some of the
An insurance company is liable to pay compensation in an accused, they are now looking at "12 states and counting".
accident case involving a truck driver without a proper li-
They cited the case of Trilok Kumar in Delhi as an example.
cence if it fails to establish negligence on part of the vehicle The first time Kumar died, it was cancer. That's what MCD
owner in verifying the driver's licence, Gujarat high court records and receipts from the Nigambodh Ghat cremation
has ruled.
office in Delhi showed. A resident of Shaktinagar, Kumar was
The observation came while dismissing a petition by ICICI cremated on June 19, 2024, with an official Municipal Corpo-
Lombard General Insurance Co Ltd, which challenged a ration of Delhi (MCD) document listing cancer as the cause
motor accident claims tribunal's order awarding compen- of death. That should have been the end of his story. It wasn't.
sation to an accident victim.
Six months later, an MCD death certificate surfaced, now
One Jayesh Dharavia of Jamnagar died in a road accident claiming Kumar had died on Dec 27, 2024, at Govind Ballabh
involving a truck in 2010. The truck driver, Ramsingh Yadav, Pant Hospital. This time it was cardiopulmonary arrest. The
had a licence to drive a two-wheeler and a light motor ve- paperwork was flawless- stamps, seals, signatures.
hicle, but not a truck, which falls in the category of a heavy "You can't admit a man who's already dead, run medical
motor vehicle. In 2014, a motor accident claims tribunal tests on him, and then hand over his body - all in a single
ordered truck owner Suresh Chandra and his insurer, ICICI
day," said Sambhal ASP Anukriti Sharma, one of the lead
Lombard, to pay Rs 19 lakh, along with 7.5% interest, as
investigators in a case that has exposed what police in UP
compensation to the deceased's family.
are calling "one of the most calculated and ruthless insur-
The insurance company moved HC, contending that the ance swindles" in recent memory.
driver was not authorised to drive the truck. Citing breach A senior doctor at GB Pant Hospital said: "When a patient ar-
of policy terms and the vehicle owner's failure in employing rives in the emergency, we do not waste time on formalities.
a qualified driver with a valid licence, the company argued But if scammers convince a patient to provide a false name in
that it could not be held liable to pay the compensation.
exchange for money, with the promise of guaranteed treat-
The HC said the insurer had failed to establish that it had ment, there is a possibility that the patient may comply."
requested the vehicle owner to verify the driver's licence, Sharma added, "Since PMJJBY does not require thorough
or that it had drawn the owner's attention to be vigilant in nominee verification, fraudsters took out multiple policies,
this regard.
waited 45 days, then forged death certificates to claim
payouts. They used different names and took advantage of
12 states and counting: 'Death insur- minimal checks."

ance' scam probe widens Sambhal SP Krishan Kumar Bishnoi said, "We have arrested
Trilok Kumar died twice in six months. That is confirmed by 16 people, including women, so far."
official records from two govt institutions. The insurance
payout came twice, too. Mis-selling: Full premium must be re-
turned
Days after uncovered an elaborate insurance scam originat-
ing in UP and running into hundreds of crores - where insur- During the discussion, the agent assured Singh that he would
ance agents, claims officials, panchayat authorities and even need to pay a one-time premium only and that, 18 months
doctors and bank staff conspired and colluded to insure the later, he would receive promising returns. Singh fell for the
dying and sometimes the dead - investigators now say the glib sales talk. In early 2009, he purchased five policies worth

The Insurance Times April 2025 49