ICICI Lombard Must Pay ₹50 Lakh Death Claim After Failing to Back Its Rejection
ICICI Lombard must pay ₹50 lakh to the policyholder’s family after failing to back its rejection of the death claim.
ICICI Lombard has been directed to pay a ₹50 lakh death claim after failing to substantiate its rejection of the policyholder’s claim.
ICICI Lombard: A motorcycle ride on a April afternoon in Andhra Pradesh ended in a fatal collision. Months later, the dead man’s family was in a consumer court, contesting an insurer’s refusal to honour a ₹50 lakh policy. The District Consumer Disputes Redressal Commission in Kurnool has now held ICICI Lombard General Insurance Company Limited liable for deficiency in service, ruling that the company turned down the claim without a valid, substantiated ground under the policy.
The Commission is headed by President Karanam Kishore Kumar, with Members N. Narayana Reddy and S. Nazima Kausar. It partly allowed the complaint filed by Yellala Jagadeeshawara Reddy, who is the brother and nominee of the late Divakar Reddy Yellala. The Commission directed the insurer to pay ₹50,00,000 towards the sum assured, ₹20,000 as compensation for mental agony and ₹5,000 towards litigation costs.
ICICI Lombard: The Policy, the Accident and the Rejection
Divakar Reddy Yellala held a policy from ICICI Lombard with a sum assured of ₹50 lakh. Coverage ran from December 19, 2024 to December 18, 2025, against a premium of ₹4,767. On April 14, 2025, while he was riding his motorcycle, an unidentified vehicle allegedly struck it. He suffered bleeding injuries and died at the spot.
The FIR, the inquest report and the post-mortem report all established that the accident took place and that it caused his death. The post-mortem recorded the cause of death as head injury. His nominee submitted a claim form to the insurer. ICICI Lombard rejected it, stating that its scrutiny and verification had indicated misrepresentation of facts to obtain the insurance benefit.
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The nominee then approached the Commission. He sought the ₹50 lakh sum assured, interest at 24 per cent from the date of death, ₹1 lakh as compensation for mental agony and the costs of litigation.
ICICI Lombard: What the Insurer Argued
ICICI Lombard told the Commission that the complainant had not supplied the documents needed to process the claim, despite repeated communications. It pointed in particular to the Police Final Report and other claim-related records that had not been submitted. On that basis, it maintained that there was no deficiency in service on its part.
ICICI Lombard: What the Commission Found
The Commission examined whether the insurer’s requests for documents had actually reached the complainant. It noted that ICICI Lombard had placed no postal receipts, acknowledgements, tracking reports, courier records or email delivery reports on record. The rejection letter listed the dates of the communications, but the Commission held that this alone did not prove they were served, or that the complainant had been given a reasonable opportunity to respond.
The Commission also took note of the insurer’s own field investigation report, prepared by Dr. Penubakula P. Malleswara Rao. That report found the incident to be genuine and the cause of death to be head injury. It recommended the claim as payable, subject to the Police Final Report under the policy terms. According to the Commission, the insurer produced nothing to show that the accident was fabricated. It also produced nothing to show that later police proceedings had disproved the accident, changed the cause of death or otherwise disqualified the complainant from the benefit.
On the allegation of misrepresentation, the Commission observed that the insurer had not named the specific fact the deceased was said to have misrepresented. Nor had it shown how any such misstatement was material to its decision to accept the risk. The insurer also did not establish that the lack of a Police Final Report ended or suspended its contractual liability.
ICICI Lombard: The Order and Its Terms
The Commission held that repudiating or leaving the claim unsettled without establishing a valid and substantiated ground under the policy amounted to deficiency in service. It partly allowed the complaint and issued the payment directions set out above.
The order also sets a deadline. If ICICI Lombard does not comply within 45 days of receiving it, the ₹50 lakh sum assured will carry interest at 9 per cent per annum from October 6, 2025, the date the complaint was filed, until the amount is realised.
Sri S. Siva Rama Krishna Prasad appeared as counsel for the complainant. Sri P. Ramanjaneyulu appeared for ICICI Lombard.
