A Delhi consumer court has ordered Manipal Cigna Health Insurance Company to pay more than Rs 14.6 lakh to the family of a deceased policyholder, calling its rejection of a death claim both medically absurd and highly insensitive. The North Delhi District Consumer Disputes Redressal Commission-I ruled that demanding diagnostic cardiac tests from a patient actively undergoing cardiopulmonary resuscitation in an emergency room is humanly impossible and legally unsustainable.
The three-member bench, comprising President Divya Jyoti Jaipuriar and members Ashwani Kumar Mehta and Harpreet Kaur Charya, ordered the insurer to pay Rs 12.10 lakh in policy benefits along with 9 percent annual interest. The court also slapped a separate Rs 5 lakh punitive fine on Manipal Cigna for using highly inappropriate language in its rejection letter, and penalized the home loan lender, Indiabulls Rural Finance, for initiating debt recovery actions against the grieving widow while her claim was still pending.
Emergency Medical Crisis and Claim Denial
The dispute originated during the Covid-19 pandemic in April 2021. The deceased, Pankaj Srivastava, had secured a Rs 10.57 lakh home loan from Indiabulls Rural Finance in June 2019, which included a one-time insurance premium of Rs 64,448 for a group insurance policy with Manipal Cigna. The policy provided a Rs 7 lakh critical illness benefit, Rs 5 lakh for an education fund, and Rs 10,000 for funeral expenses, with his wife, Kanak Lata, named as the beneficiary.
On April 1, 2021, Srivastava fell ill with a cough and sore throat, which developed into a fever two days later. By the morning of April 4, he began experiencing severe breathlessness. Although a rapid Covid-19 test at the Aruna Asaf Ali Government Hospital was negative, his condition worsened later that night. He was rushed back to the hospital in a gasping state with unrecordable blood pressure and pulse. Emergency room doctors immediately initiated cardiopulmonary resuscitation and other resuscitation efforts, but Srivastava could not be revived and was declared dead at 11:15 p.m. due to sudden cardiac arrest.
Kanak Lata submitted an insurance claim following his death. However, Manipal Cigna rejected it in November 2021, arguing that the family failed to provide diagnostic evidence, such as electrocardiogram changes, troponin test results, elevated cardiac enzymes, or a post-mortem report, to prove he had suffered a myocardial infarction. The insurer maintained that sudden cardiac arrest was not a covered critical illness under their contract terms.
Commission Dismisses Technical Objections
In its ruling on June 29, the consumer commission rejected the insurer’s defense. The bench noted that expecting doctors to pause active, life-saving resuscitation efforts to perform highly specialized diagnostic tests is completely contrary to medical science and practice. It stated that a post-mortem is not mandatory in every case of natural death, and its absence cannot justify denying a genuine claim.
The commission highlighted that the insurer did not present any expert medical evidence to support the distinction it drew between sudden cardiac arrest and myocardial infarction. It added that such technical differences were never explained to consumers when the policy was sold and could not be used retrospectively to block benefits. Referencing established Supreme Court precedents, the tribunal emphasized that insurance contracts must be interpreted in favor of policyholders and cannot be rejected on hyper-technical grounds.
Penalties for Insensitivity and Unfair Practices
The commission also strongly condemned the language used in Manipal Cigna’s rejection letter, which stated that the deceased was accustomed to death. Characterizing the phrasing as grammatically grotesque, illogical, and deeply insensitive to a grieving widow, the bench ruled that it showed a complete lack of application of mind and damaged public trust in the insurance sector. The court ordered Manipal Cigna to deposit a Rs 5 lakh fine into the Consumer Welfare Fund within 45 days.
The commission ordered the insurer to pay the Rs 12.10 lakh in policy benefits with 9 percent simple interest calculated from November 18, 2021, along with Rs 1 lakh for mental harassment and Rs 25,000 in litigation costs.
Furthermore, the commission found Indiabulls Rural Finance guilty of unfair trade practices for attempting to recover loan dues from the widow while the insurance claim remained unresolved. The lender was ordered to pay Rs 1 lakh in compensation, Rs 25,000 in litigation costs, and provide an updated loan statement. The insurer has been directed to clear the outstanding home loan amount directly with the lender first and release any remaining funds to the complainants.
