Insurance company to pay over Rs 98 L for denying compensation after husband's death
Swedha Pothiraj of Arumbakkam stated that her late husband, Sreyas RV, purchased a Rs 1 crore term life insurance policy in April 2020 from ICICI Prudential Life Insurance Co. Ltd.
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CHENNAI: A city consumer commission has directed an insurance company and its broker to pay compensation of over Rs 98 lakh to a woman whose husband's life insurance claim was denied.
Swedha Pothiraj of Arumbakkam stated that her late husband, Sreyas RV, purchased a Rs 1 crore term life insurance policy in April 2020 from ICICI Prudential Life Insurance Co. Ltd. and Gennext Insurance Brokers Pvt Ltd. He paid the required premiums for the 48-year policy.
Sreyas later died from acute-on-chronic liver failure, leading to multi-organ failure and septic shock. When Swedha submitted a claim, ICICI Prudential rejected it in February 2023. The insurer cited "non-disclosure" of medical history and noted the claim's size (over Rs 30 lakh) made the Insurance Ombudsman route unavailable.
Swedha countered that at the time of the online application, Sreyas truthfully answered "no" to questions asking if he had undergone any significant tests, treatments, or hospitalisations. She asserted he had no prior serious ailments or hospitalisations for liver failure.
The insurer referenced a 2019 lab report in Sreyas's name. Swedha explained this was likely from a routine medical test required for his job-related international travel as a senior manager, not indicative of prior illness or treatment.
"Sreyas was working as a Senior Manager and used to visit foreign countries on account of his job nature, and before one such travel abroad, he had visited a medical test laboratory as a routine matter of medical tests," she said. She argued the claim rejection constituted a deficiency in service.
The Chennai North District Consumer Disputes Redressal Commission, comprising president D Gopinath and members Kavitha Kannan and V Ramamurthy, ruled in Swedha's favour.
It directed the insurers to pay the sum assured of Rs 98.28 lakh (after deducting the refunded premium of Rs 1.71 lakh); Rs 25,000 as compensation for deficiency in service, mental agony, pain, and suffering and Rs 5,000 towards litigation costs.
