Kurnool Consumer Commission Directs ICICI Lombard To Pay ₹50 Lakh Accident Insurance Claim; Holds Insurer Cannot Introduce New Conditions At Claim Stage
The District Consumer Disputes Redressal Commission, Kurnool, comprising President Sri Karanam Kishore Kumar and members Sri N. Narayana Reddy and Smt. S. Nazima Kausar, has held that insurance companies cannot reject claims on hyper-technical grounds when the occurrence of an insured event is established by cogent evidence. The Commission partly allowed a complaint filed by the nominee of...
The District Consumer Disputes Redressal Commission, Kurnool, comprising President Sri Karanam Kishore Kumar and members Sri N. Narayana Reddy and Smt. S. Nazima Kausar, has held that insurance companies cannot reject claims on hyper-technical grounds when the occurrence of an insured event is established by cogent evidence.
The Commission partly allowed a complaint filed by the nominee of the deceased policyholder against ICICI Lombard General Insurance, observing that the insurer's insistence on Income Tax Returns and bank statements at the claim stage, when such details were not required during the proposal stage, amounts to an impermissible introduction of new conditions post-contract.
Facts
The complainant, Smt. Gandla Prameela, is the nominee of her deceased husband, Late Sri Gandla Mulaiah, who had obtained a life insurance policy from ICICI Lombard General Insurance with an accidental death benefit of Rs. 50,00,000. On July 28, 2025, during the subsistence of the policy, the insured was hit by a rashly driven mini truck near Tellapuri Village and succumbed to his injuries the same day.
Following the accident and death, an FIR was registered by the Gospadu Police, and upon completion of the investigation, a charge sheet was filed before the Judicial First Class Magistrate, Allagadda. When the complainant submitted her claim along with the FIR, inquest report, post-mortem report, and the charge sheet, the insurance company repudiated the claim, asserting that the "Police Final Report" had not been submitted.
Aggrieved, the complainant approached the consumer commission.
Contention of the Insurer
ICICI Lombard argued that the complaint was not maintainable and that the complainant had failed to furnish mandatory documents necessary for processing the claim despite repeated reminders. The insurer specifically highlighted the absence of the Police Final Report, the insured's Income Tax Returns with complete computation, and a one-year bank statement preceding the policy's commencement. They maintained that the claim was rightly repudiated as they were unable to adjudicate it based on the documents provided.
Observations of the Commission
The Commission observed that the accidental death of the insured was conclusively established by the FIR, post-mortem report, inquest report, charge sheet, and death certificate. It held that the charge sheet filed by the police after completion of the investigation constituted the final police report and had already been furnished by the complainant. Therefore, repudiation of the claim on the ground of non-submission of the "Police Final Report" was unsustainable.
With regard to the insurer's insistence on the Income Tax Returns and bank statements, the Commission observed that the insurer had accepted the proposal by recording the insured's occupation as "self-employed" without requiring any income proof or ITRs at the proposal stage. Having accepted the risk and issued the policy, the insurer could not subsequently introduce new conditions at the claim stage by insisting upon documents that were neither part of the proposal requirements nor relevant to adjudication of an accidental death claim.
Relying on the Supreme Court's decision in Gurmel Singh v. Branch Manager, National Insurance Company (2022), the Commission reiterated that insurance companies should not adopt a hyper-technical approach while considering genuine claims or insist upon documents that have no nexus with the claim.
The Commission further observed that it is a settled principle of law that once accidental death is established through the FIR, post-mortem report, and charge sheet, insistence on additional documents having no direct bearing on the claim amounts to arbitrary repudiation.
It further held that the insurer had failed to establish how the non-submission of the Income Tax Returns or bank statements would affect adjudication of the accidental death claim. The insistence on such documents was arbitrary and amounted to deficiency in service
Decision
Holding that the repudiation of the insurance claim on technical and unreasonable grounds amounted to deficiency in service, the Commission partly allowed the complaint. It directed ICICI Lombard General Insurance Company to jointly and severally pay the complainant the accidental death benefit of ₹50,00,000, along with ₹20,000 as compensation for mental agony and ₹10,000 towards litigation costs within 45 days.
The Commission further ordered that, in case of default, the sum assured of ₹50,00,000 would carry interest at 9% per annum from the date of filing of the complaint until realization.
Case Title: Gandla Prameela v. ICICI Lombard General Insurance Company Ltd. & Anr.
Case No.: Consumer Complaint No. 174/2025