Penolakan Klaim Asuransi Jiwa sebagai Perbuatan Melawan Hukum yang Merugikan Tertanggung (Studi Putusan Nomor 369/Pdt.G/2023/Pn Mdn)

Abstract

The rejection of life insurance claims by insurance companies often becomes a significant legal problem for the insured, especially if the claim is valid based on the applicable policy provisions. This research aims to analyze the rejection of life insurance claims by insurance companies as an unlawful act that harms the insured with a case study of judgment Number 369/Pdt.G/2023/PN Mdn, as well as the legal implications caused. This case originated from the rejection of an insurance claim by PT Asuransi Allianz Life Indonesia on the grounds that the insured's identity did not match, even though insurance premium had been paid regularly. The plaintiff, as the heir, considered the company's actions as an attempt to avoid the obligation to pay claims. Based on the study of insurance law and the principle of good faith, this research highlights the obligations of insurance companies in fulfilling the rights of the insured as well as the legal implications of unreasonable claim rejection. This research uses a normative juridical approach by analyzing the court decision in case No. 369/Pdt.G/2023/PN Mdn, which involves a life insurance claim dispute between the insured and the insurance company. The focus of this research is to examine whether the rejection of the claim has violated the rights of the insured, as well as the legal consequences arising from the rejection of claims that are not in accordance with legal provisions and principles in the insurance industry. The results showed that insurance claim rejection can be caused by internal and external factors. Internal factors include administrative errors, strict interpretation of the policy, strict underwriting procedures, and the application of exclusion clauses. Meanwhile, external factors include customer negligence such as late reporting, document discrepancies, or risks not covered by the policy. In addition, unclear claim rejections can cause material and immaterial losses to the insured, as well as potentially damage the reputation of the insurance company in the eyes of the public. The Panel of Judges decided that the rejection of claims by PT Asuransi Allianz Life Indonesia was unlawful because it caused material and immaterial losses to the Plaintiff. The view of the panel of judges in the case is that life insurance companies are obliged to pay claims to the insured, which shows that consumer rights must be respected and protected by law.