Care Health Insurance has been directed to pay roughly Rs 40.76 lakh to a father whose son died in a US road accident, after a Delhi consumer forum determined that the company improperly denied the claim by repeatedly demanding documents it had already received.
The West Delhi District Consumer Disputes Redressal Commission-III issued the ruling on July 6, instructing the insurance firm to fulfill the policy payout along with 7 percent interest calculated from the complaint’s filing date until final payment. Additionally, the panel ordered the insurer to pay Rs 50,000 to cover litigation costs and compensate for mental agony and harassment. The company must complete the payments within 30 days.
Repeated Demands Lead To Rejection
The case stems from the death of Dev Singh, who was killed in a road crash in Los Angeles, California, on November 4, 2021. He had purchased a travel insurance policy named Explore Gold-WW on August 30, 2021, paying a premium of Rs 9,633. The cover was active through February 25, 2022, and carried an accidental loss cover of US$50,000.
Following the fatal accident, the victim’s father, Rajeev Singh, who was named as the nominee, initiated the claim process. The complainant submitted all required records, including hospital files and an autopsy report, and answered every query raised by the company.
Despite receiving medical records sent in PDF format in February 2022, the insurer continued to ask for the same paperwork. Care Health Insurance eventually repudiated the claim on June 16, 2022, citing an unaddressed deficiency. The father issued a legal notice, but after receiving no resolution, filed a complaint before the consumer panel.
Forum Rejects Insurer Defense
In its response before the consumer panel, Care Health Insurance defended its decision by asserting that the policyholder’s nominee failed to submit all necessary processing documentation. The firm stated that it had issued multiple notices requesting compliance with policy requirements and closed the claim only after those issues remained unaddressed.
The bench, comprising President Sonica Mehrotra and members Richa Jindal and Anil Kumar Koushal, rejected the insurance company’s arguments. The panel observed that the company kept raising queries on unfounded grounds even though all required records were submitted. The commission concluded that the repudiation was illegal and lacked justification, making the nominee fully entitled to indemnification under the policy.
