She paid just Rs 20 a year under the Centre’s Pradhan Mantri Suraksha Bima Yojana (PMSBY) for a Rs 2 lakh accident cover. But a road accident on December 25, 2023, left the woman critically injured and claimed her life four days later, leaving her husband fighting for the promised insurance money. The insurer rejected the claim over a reporting delay. Now, a consumer commission has ordered it to pay Rs 2 lakh to the man, besides Rs 18,000 in compensation and legal costs, holding that procedural delays cannot defeat genuine claims.Tumakuru District Consumer Disputes Redressal Commission president G T Vijayalakshmi, with members Nivedita Ravish and Kumar N, was hearing one S Mahesh’s complaint alleging wrongful rejection of his wife’s Rs 2 lakh PMSBY accidental death claim by the United India Insurance Company and seeking compensation for the delay in settling the benefit.“Procedural delays should not automatically invalidate claims if the insured has acted in a good faith,” the commission said on October 5, referring to a Supreme Court ruling. It also referred to the Supreme Court’s observation that insurers have a responsibility to assess the genuineness of claims beyond procedural delays.The dispute concerned Mahesh’s wife Manjula alias Manjulamma, who died following a road accident. Although she had an active PMSBY policy promising an accidental death benefit of Rs 2 lakh, her husband was denied the payout because the insurer maintained that the claim had not been reported within the prescribed deadline.Woman dies 4 days after accidentAccording to Mahesh’s complaint, Manjula was travelling as a pillion rider on a motorcycle driven by her brother on December 25, 2023. They were heading to her sister’s house when the accident occurred near Podar School at Maralur Tank Bund in Gulur village, Tumakuru district, around 6.30 pm.The complaint stated that a vehicle approaching from the opposite direction switched on its headlights, following which the motorcycle rider moved towards the left side of the road. Manjula lost her balance and fell off the motorcycle.She suffered serious injuries, including head injuries and fractures. She was initially taken to the District Government Hospital in Tumakuru, before being referred to the National Institute of Mental Health and Neurosciences (NIMHANS) in Bengaluru, and was later shifted to KC General Hospital. She died on December 29, 2023.Story continues below this adThe postmortem report attributed her death to head injuries consistent with a road traffic accident. The commission examined the medical and police records and accepted that her death resulted from the accident.Insurer rejects claim over delayManjula had enrolled in PMSBY through the Karnataka Gramin Bank’s Urdigere branch and paid an annual premium of Rs 20 on September 26, 2023. The policy provided an accidental death benefit of Rs 2 lakh, payable to the nominee.Mahesh lodged a police complaint on January 3, 2024, five days after her death. The claim-cum-discharge form showed that he submitted the insurance claim through the bank on February 9, 2024, 42 days after her death.The United India Insurance Company rejected the claim on September 17, 2024, arguing that the policy required nominees to notify the concerned bank within 30 days of the accident or loss and submit all relevant documents to the insurer within 60 days. The insurer maintained that it received information about the death only on February 9, 2024, and that the delay prevented it from processing the claim under the policy conditions.Story continues below this adThe commission examined the police, medical, postmortem, bank and insurance records and found that Manjula’s PMSBY policy and accidental death were established. Neither the insurer nor the bank produced evidence that Manjula or her nominee had been informed about the policy conditions and claim-reporting deadlines.Relying on Supreme Court rulings, the commission emphasised that genuine claims should not be rejected mechanically over procedural delays, particularly when the insured has acted in good faith. It held that the insurer’s refusal amounted to deficiency in service. However, it found no deficiency on the bank’s part, noting that it had forwarded the claim to the insurer.The commission directed United India Insurance Company to pay Mahesh Rs 2 lakh with 9 per cent annual interest from September 17, 2024, until realisation, along with Rs 10,000 compensation and Rs 8,000 litigation costs.TakeawayInsurers must examine genuine claims on merit and cannot reject them solely over procedural delays, particularly when policy conditions were not communicated to the insured.Story continues below this adFor consumer-related grievances, individuals may contact the consumer helpline in their respective states and Union territories (Karnataka: 1800-425-9339) or call the National Consumer Helpline at 1915 for assistance.Don’t miss out on these stories:Rs 15 bus ride sparks 14-month battle, passenger gets Rs 11,485 from KSRTCSmartphone ‘explodes’ in pant’s pocket, man wins Rs 1.23 lakh payoutDubai floods disrupt couple’s Europe trip, airline, booking platform to pay Rs 1.88 lakh