A consumer commission has directed an insurer to honour a ₹30 lakh accidental death insurance claim that had been rejected on the ground of alcohol consumption. The commission reportedly found discrepancies in the medical records relied upon for repudiation and upheld the policyholder’s claim, directing payment of the ₹30 lakh claim amount with 9% interest, along with ₹75,000 as compensation. The case highlights the importance of establishing a clear evidentiary connection between an exclusion and the insured event before repudiating a claim.
For insurers, the decision reinforces the need for consistent medical documentation, careful claims investigation and evidence-based application of policy exclusions. The presence of alcohol in medical records, by itself, may not necessarily establish that an accident or death falls outside coverage; the relevance of the exclusion must be assessed against the actual policy wording and circumstances of the insured event. For policyholders, the case also underscores the importance of preserving medical records and challenging a repudiation where the insurer’s evidence or interpretation of the exclusion is disputed.
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