State Life Insurance Ordered to Pay Family of Deceased Policyholder Along with Profit

State Life Insurance Ordered to Pay Family of Deceased Policyholder Along with Profit

Islamabad, November 5, 2023 – President Dr. Arif Alvi has issued a directive to the State Life Insurance Corporation of Pakistan (SLICP) to fulfill a long-awaited death insurance claim, amounting to Rs 300,000, alongside accrued profits, for the family members of a deceased policyholder.

The claim had been pending for nearly three years.

In addition to ordering the payment of the outstanding claim, President Alvi has instructed the SLICP to establish a panel of medical experts tasked with formulating a comprehensive policy concerning pre-insurance medical tests for prospective policyholders.

This decision was made in response to the rejection of a representation filed by the SLICP against the decision of the Wafaqi Mohtasib, as confirmed in a press release issued by the President Secretariat Press Wing on Sunday.

The dispute centers around a complaint lodged by Saad Taheer, who alleged that his father had purchased a life insurance policy from SLICP in 2013, with a sum assured of Rs 300,000 and an annual premium of Rs 18,406. In 2020, Saad’s father passed away, prompting him to file a death insurance claim. However, the claim was initially denied by SLICP on the grounds that the deceased had undisclosed pre-insurance ailments, particularly hepatitis-C, which was deemed a deliberate concealment.

In light of these circumstances, Saad Taheer approached the Wafaqi Mohtasib, which subsequently instructed SLICP to reevaluate the case and offer appropriate relief to the nominees of the deceased policyholder. In response, SLICP lodged a representation against the Ombudsman’s decision.

President Alvi conducted a hearing on the matter, during which he heard arguments from both parties. In his decision, the President highlighted that the policy was purchased in 2013, whereas SLICP had presented copies of medical reports from 2015 and onward, all of which were post-insurance period documents and, therefore, not relevant to the claim. He also emphasized that the confidential report from the SLICP field officer had affirmed the insured’s good health at the time the policy was issued, specifically stating that the officer had known the insured for two years.

President Alvi further invoked Section 80 of the Insurance Ordinance 2000, which stipulates that after two years from the policy’s inception, the insurer cannot contest the policy on the grounds of false or inaccurate statements in the insurance proposal or medical reports.

In light of these considerations, President Alvi rejected SLICP’s representation and ordered the immediate payment of the insurance claim, along with the accrued profit, to the deceased policyholder’s nominees. The President also proposed the formation of a panel of medical experts to advise SLICP on establishing a comprehensive policy for pre-insurance medical tests.

“This panel of doctors would suggest what the most common and prevalent diseases are in Pakistan and recommend the necessary tests before issuing a policy,” the President stated. He also suggested that SLICP could create a risk assessment for different diseases and adjust premiums accordingly if they intended to issue policies to individuals with mild and common ailments, such as diabetes, hypertension, or hepatitis.