The Madhya Pradesh State Consumer Disputes Redressal Commission, with Shri AK Tiwari (Acting President) and Dr. Monika Malik (Member), rejected an appeal against ICICI Lombard General Insurance Company. The decision was based on medical reports of the deceased, which identified alcohol as a contributing factor to his illness. The commission upheld the validity of the insurance company’s denial of the claim, noting that the deceased’s illness did not fall within the policy’s coverage.
Summary of Events
The late husband of the Complainant had purchased a medical insurance policy worth Rs. 25 lakhs from ICICI Lombard General Insurance Co. Ltd. (“Insurance Company”), for which he paid a premium of Rs. 75,000/-. The policy was effective from 19.03.2019 to 18.03.2024, with the Complainant listed as the nominee.
In December 2019, he fell ill and was admitted to Birla Hospital in Gwalior. Unfortunately, he passed away on 11.12.2020. During his treatment, the Complainant incurred medical expenses totaling Rs. 2 lakhs. Upon seeking reimbursement from the Insurance Company, her claim was rejected. Dissatisfied with this decision, the Complainant subsequently filed a consumer complaint with the District Consumer Disputes Redressal Commission, Morena, Madhya Pradesh (“District Commission”).
Overview of the Case
The late husband of the Complainant had purchased a medical insurance policy valued at Rs. 25 lakhs from ICICI Lombard General Insurance Co. Ltd. (“Insurance Company”), paying a premium of Rs. 75,000. The policy was active from 19.03.2019 to 18.03.2024, with the Complainant named as the nominee.
In December 2019, he fell ill and was admitted to Birla Hospital in Gwalior. Tragically, he passed away on 11.12.2020. During his hospitalization, the Complainant incurred medical expenses amounting to Rs. 2 lakhs. Upon approaching the Insurance Company to claim the insurance amount, her claim was denied. Feeling aggrieved by this decision, the Complainant lodged a consumer complaint with the District Consumer Disputes Redressal Commission, Morena, Madhya Pradesh (“District Commission”).
The State Commission determined that the Insurance Company’s reasons for denying the claim were justified. The deceased’s illness was not listed as covered under the policy, and conditions arising from the use, consumption, or abuse of alcohol were explicitly excluded from coverage.
In light of these findings, the State Commission concluded that the Insurance Company did not fail in its service obligations. Consequently, the District Commission’s decision was upheld, and the appeal was dismissed.
Posted and reproduced in Public Interest by
Adv. Sulaiman Bhimani Legal Consultant
Expert in RERA & Consumer Matters, Co-operative Scty Matters,
Deem Conveyance, Family Matters, and Property Disputes.
Human and Civil Rights Campaigner
President Citizens Justice Forum https://citizensjusticeforum.in
YouTube Channel https://tinyurl.com/CitizensJusticeForum
NEW CHANNEL FOR STOCK MARKET https://tinyurl.com/GreenWallet
WhatsApp +91 99877 43676