The Kurnool Consumer Commission has directed ICICI Lombard General Insurance Company to pay a ₹50 lakh insurance claim after finding that the insurer failed to substantiate its decision to reject the claim on grounds of alleged misrepresentation.
The case involved a life insurance policy taken by the deceased, with a sum assured of ₹50 lakh. The policy was issued on December 19, 2024, and remained valid until December 18, 2025. The premium paid was ₹4,767, while the deceased’s brother was named as the nominee.
Insured died in road accident
The insured died in a road on April 14, 2025, after an unknown vehicle allegedly hit his motorcycle. The insurance policy was active on the date of the accident.
Following the death, the nominee informed ICICI Lombard about the incident and submitted the claim form and other documents seeking payment of the policy benefit.
The insurer, however, subsequently repudiated the claim.
Insurer cites misrepresentation and missing documents
there had been misrepresentation of facts to obtain the insurance benefit. The insurer also claimed that the nominee had failed to submit several documents required to process the claim.
According to the insurer, it had repeatedly asked the nominee to provide additional documents, including the police final report, income-tax returns, a cancelled cheque and other claim-related papers.
The insurer maintained that despite several reminders, the required documents were not submitted. It subsequently closed the claim and repudiated it.
In an email dated June 28, 2025, ICICI Lombard stated that further scrutiny and verification of the claim documents had revealed misrepresentation of facts to obtain the insurance benefit. It said the claim therefore fell outside the policy’s terms and conditions.
Commission questions proof of reminders
The Consumer Commission examined the insurer’s contention that it had repeatedly contacted the nominee.
The insurer referred to communications allegedly sent on May 17, 19, 21 and 25, 2025. However, it did not produce postal receipts, acknowledgements, tracking reports, courier records, email delivery reports or other evidence establishing that the communications had actually been dispatched and received by the nominee.
The Commission held that merely mentioning the dates of alleged communications was not enough to establish that the nominee had received them or had been given a reasonable opportunity to comply with the insurer’s requests.
No evidence that missing police report invalidated claim
The Commission also observed that the insurer had not established that the absence of the police final report at that stage extinguished or suspended its contractual liability.
It further noted that the insurer had not produced evidence showing that the eventual police report contained any adverse finding that could justify rejection of the claim.
The Commission therefore concluded that the insurer had failed to establish a valid and substantiated ground under the policy terms for repudiating or withholding the claim.
ICICI Lombard directed to pay ₹50 lakh
The Commission held that the repudiation and non-settlement of the insurance claim amounted to a deficiency in service.
It accordingly ruled that the nominee was entitled to receive the full ₹50 lakh sum assured under the policy.
The case highlights the importance of insurers providing evidence to substantiate claim repudiation and demonstrating that policyholders or nominees were given a reasonable opportunity to provide any additional documents sought during the claim process.