Gurugram Consumer Panel Orders Rs 33.4 Lakh Insurance Payout

A Gurugram consumer commission has directed an insurer to pay a Rs 33.40 lakh claim to the family of a deceased policyholder, along with nine per cent annual interest. The order also awards Rs 2 lakh for mental harassment and Rs 55,000 towards legal costs, making the case a significant local reminder that rejection letters can be tested before a consumer forum.

The complaint was filed by Naina Yadav, a resident of Sector 7 Extension. Her husband, Chirag Yadav, had bought a plot in Sector 46 in 2018 and taken a bank loan for construction. An insurance product linked to the borrowing provided cover in the event of death or disability, according to the case placed before the district commission.

Chirag developed severe chest pain on August 30, 2022, was admitted to a private hospital and died during treatment on September 1. When the family submitted a claim, the insurer rejected it on the ground that he had allegedly had diabetes for five years and had not disclosed the condition when the loan and policy were taken.

The commission, headed by president Sanjeev Jindal, did not accept that defence. Its order said the insurer carries responsibility for appropriate medical examination before issuing a policy and could not rely on a pre-existing-illness argument in the circumstances established before the forum. It also found no proved direct link between diabetes and the cardiac arrest identified as the main cause of death.

The claim amount is to carry nine per cent annual interest from September 29, 2022 until payment. The separate awards for harassment and litigation expense recognise that the cost of an unjustified rejection is not limited to the policy sum. A bereaved family may spend years collecting records, corresponding with the insurer and pursuing a case.

The decision should not be read as a blanket rule that disclosure questions never matter. Insurance disputes turn on the proposal form, medical evidence, policy wording and the relationship between an alleged omission and the claim. The order reflects the evidence and reasoning in this particular case; insurers retain whatever appeal rights the law provides.

For consumers, the practical lesson begins before a dispute. Proposal forms should be answered personally and accurately, even when an agent fills them in. Copies of the signed form, medical tests, premium receipts, policy schedule, loan papers and all emails should be retained. After a rejection, the family should request the exact policy clause and medical basis in writing.

A reasoned order is more useful than a slogan about consumer rights because it shows where responsibility was placed and what remedy followed. The next step will be compliance or any lawful challenge by the insurer. Until then, the Gurugram ruling stands as a substantial award in favour of the complainant, not as a final pronouncement on every pre-existing-disease claim.