An insurance company cannot introduce additional document requirements or new eligibility conditions after issuing an insurance policy, the Kurnool District Consumer Disputes Redressal Commission in Andhra Pradesh has ruled while directing ICICI Lombard General Insurance to honour an accidental death insurance claim.
According to a report by The Times of India , the commission ordered the insurer to pay Rs 50 lakh to the nominee of a policyholder who died in a road accident. The insurer has also been directed to pay Rs 20,000 as compensation for mental agony and Rs 10,000 towards litigation expenses.
What led to the dispute?
As per the commission's order cited by The Times of India , the deceased had purchased an accidental death insurance policy from ICICI Lombard with a coverage of Rs 50 lakh . The policy remained valid from June 9, 2025, to June 8, 2028 , and the annual premium was Rs 14,445 .
Less than two months after buying the policy, the insured died in a road accident on July 28, 2025 , after being hit by a mini truck. Police registered an FIR, investigated the case and eventually filed a charge sheet before the competent court.
Following the policyholder's death, his wife, who was the nominee under the insurance policy, submitted a claim along with documents such as the policy certificate, FIR, post-mortem report, inquest report, death certificate and the police charge sheet.
The insurance company, however, declined the claim. It initially stated that the final police report had not been furnished and later sought additional documents, including the deceased's income tax returns and bank statements for one year. The insurer maintained that the claim could not be processed without those records.
Why did the commission reject the insurer's stand?
The consumer commission, comprising President Karanam Kishore Kumar and members N. Narayana Reddy and S. Nazima Kausar, found that the nominee had already submitted sufficient evidence to establish that the death resulted from an accident.
It observed that the police charge sheet represented the final outcome of the investigation and had already been filed before the jurisdictional criminal court. Therefore, the insurer's objection regarding the absence of the final police report was not sustainable.
The commission also noted that when the insurance policy was issued, ICICI Lombard had accepted the proposal without asking for proof of income, income tax returns or bank statements. Having accepted the risk on those terms, the insurer could not later insist on additional documents that were never part of the original policy requirements.
The bench further observed that the company failed to show how the deceased's financial records were relevant to deciding an accidental death insurance claim. Since neither the occurrence of the accident, the cause of death nor the validity of the insurance policy was disputed, the rejection of the claim amounted to deficiency in service, it held.
Commission's directions
The commission directed ICICI Lombard to:
- Pay the Rs 50 lakh sum insured to the nominee.
- Pay Rs 20,000 as compensation for mental agony.
- Pay Rs 10,000 towards litigation costs.
The order requires the insurer to make the payment within 45 days . If it fails to comply within the stipulated period, the insured amount will carry 9% annual interest from the date the consumer complaint was filed until the amount is paid.
