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Insurance Claim : Kurnool Consumer Commission Holds ICICI Lombard Liable For
The , comprising President Karanam Kishore Kumar and Members N. Narayana Reddy and S. Nazima Kausar, has held liable for for wrongfully repudiating a genuine life insurance claim. The Commission directed the insurer to pay ₹50 lakh as the , along with and .
The Case of a Fatal Accident
The complainant, Yellala Jagadeeshawara Reddy, is the brother and nominee of the deceased, Divakar Reddy Yellala. The deceased had obtained a life insurance policy from ICICI Lombard with a of ₹50 lakh, valid from , to , after paying a premium of ₹4,767.
On , while riding his motorcycle, the insured was struck by an unknown vehicle on NH-40 near Govindapalle Village. He sustained severe head injuries and died on the spot. The FIR, inquest report, and post-mortem report confirmed the accident and the cause of death as “Head Injury.” The complainant promptly filed a claim with ICICI Lombard, but the insurer repudiated it via email on , citing alleged and failure to submit required documents.
Insurer’s Defence Falls Short
ICICI Lombard contended that despite multiple letters sent between May 17 and , the complainant failed to provide necessary documents, including the police final report, income tax returns, and other records. The insurer argued that the was justified under the policy terms.
However, the Commission found no evidence that these communications were actually dispatched or served on the complainant. “The mere mention of certain dates of alleged communications in Ex.B2 cannot, by itself, establish that such communications were in fact sent to and received by the complainant,” the bench observed, noting the absence of postal receipts, courier records, or email delivery reports.
Investigator’s Report Contradicts
A critical factor was the field investigation report submitted by the insurer’s own investigator, Dr. Penubakula P. Malleswara Rao. The report concluded: “Based on the above findings and evidence collected, incident found genuine and cause of death as per post mortem examination is due to head injury.” The investigator described the claim as “pro payable subject to police final report as per policy T/C.”
The Commission noted that the investigation did not uncover any evidence of fraud or fabrication. The insurer failed to produce any subsequent police findings that would disprove the accident or alter the cause of death. Furthermore, ICICI Lombard did not identify which specific fact was allegedly misrepresented or how such misrepresentation was .
Established
The Commission emphasized that without a valid, substantiated ground under the policy terms constitutes . “The Opposite Party has not specifically identified the particular fact which was allegedly misrepresented by the life assured. It has also not established what declaration made by the life assured was false, when such alleged misrepresentation was made, or how the alleged misrepresentation was ,” the order stated.
The policy remained in force for nearly four months before the accident, and all documentary evidence—FIR, post-mortem report, and the insurer’s own investigation—corroborated the genuine nature of the claim.
Commission’s Decision and Relief
Partly allowing the complaint, the Commission directed ICICI Lombard to pay ₹50,00,000 as the , ₹20,000 as , and ₹5,000 as . The order further stipulates that if the insurer fails to comply within 45 days from receipt of the order, the shall carry from the date of the complaint () until realization.
The ruling reinforces the principle that insurance companies cannot repudiate legitimate claims on vague allegations without concrete evidence. It also highlights the importance of maintaining proper records of communication with claimants.
