A consumer commission has upheld a ₹30 lakh accidental death insurance claim after an insurer rejected the payout citing the deceased’s alcohol consumption. The commission reportedly found discrepancies in the medical records relied upon by the insurer and directed the claim to be settled with 9% interest, along with ₹75,000 compensation. The case highlights the importance of reliable medical evidence and proper assessment of policy exclusions when determining accidental death claims.
The ruling is significant for insurers because repudiation based on alcohol consumption requires careful examination of the medical evidence, cause of death and precise policy terms. For claims teams, the case reinforces the need for consistent documentation, verification of medical records and a clear evidentiary basis before rejecting a claim. For policyholders, it also demonstrates the importance of obtaining and preserving medical and claim-related records when challenging a repudiation.
Want to deepen your expertise beyond today’s news?
Explore practical certification courses designed for banking, risk, insurance, compliance, ESG, AI, and emerging technologies professionals.
Learn from industry experts and earn certifications from RMAI and BFSI Sector Skill Council of India.
#Insurancenews
