Summary of this article
Consumer Commission ordered Rs 99.41 lakh insurance claim payment
Insurer failed to prove alleged forgery or medical non-disclosure
Policy remained valid because death occurred during the grace period
Nominees should retain rejection letters, medical records, and premium receipts
IndiaFirst Life Insurance rejected a son’s claim under his mother’s Rs 1 crore term policy, saying the documents relating to her income and occupation were forged or altered. Later, it said she had failed to disclose pre-existing illnesses.
The Kolkata District Consumer Commission found neither allegation supported by evidence. On September 25, 2026, it ordered the insurer to pay Rs 99.41 lakh towards the claim, along with Rs 50,000 for harassment and mental agony and Rs 10,000 towards litigation costs.
The son had approached the commission after the insurer refused payment. Besides disputing its allegations, he maintained that his mother’s policy was still valid when she died.
3 September 2026
Get the latest issue of Outlook Money
Medical Checks Before The Policy Was Issued
The woman had taken term cover of Rs 1 crore and paid Rs 58,509.12 as her first annual premium on January 23, 2022. Before accepting the proposal, the insurer checked her financial documents. She also underwent medical examinations, both in person and virtually.
About a year later, on January 30, 2023, she was admitted to hospital with a cough, fever, and difficulty breathing. She died on February 1. Her death certificate listed severe sepsis, severe pancytopenia, and acute kidney failure as the causes of death, according to a recent report by Financial Express.
Her son, named as the nominee, filed the claim in March 2023. The insurer refused to settle it, questioning the authenticity of the income and occupation documents submitted with the proposal.
The allegation about undisclosed illnesses came later, in its response to a legal notice. The son denied this and said the illnesses had developed around the time of her final hospitalisation.
There was also the question of the renewal premium, which had fallen due on January 24, 2023. The son argued that his mother died during the grace period and that the cover therefore remained valid.
No Evidence To Support The Rejection
The commission noted that the original rejection letter contained no allegation about pre-existing diseases. It regarded the insurer’s later attempt to introduce this reason as an afterthought.
Nor was there evidence showing that the illnesses recorded in the death certificate existed before the woman applied for insurance. The insurer had also failed to establish that she knowingly concealed any material fact.
The company did not appear before the commission. It filed neither a written response nor documentary evidence, and the proceedings went ahead in its absence. The panel drew an adverse inference against the insurer.
After examining the material before it, the commission held that the policy was in force when the woman died, as her death occurred within the grace period. It found the rejection unjustified and held that the insurer’s conduct amounted to deficiency in service.
What Nominees Should Keep On Record
For a nominee contesting a rejection, the insurer’s letter is an important document. It sets out the reasons given for refusing payment. Keep it with any later correspondence, particularly if the company offers a different explanation.
The policy schedule, proposal form, premium receipts, medical records and claim papers should also be available. Where renewal dates are disputed, check the grace-period terms in the policy.
If the insurer questions a document or alleges that an illness was concealed, ask it to identify the document or medical information concerned and explain the evidence behind its decision. These details can help a claimant prepare a complaint and respond to the specific grounds for rejection.
FAQs
Why did the commission reject the insurer’s allegations?
The insurer provided no evidence of forged documents or deliberate concealment of illnesses. The commission also treated its later illness-related allegation as an afterthought.
Was the policy valid when the woman died?
The commission held that the policy remained in force because her death occurred within the grace period after the renewal premium became due.
What documents should nominees keep when challenging a rejected claim?
Keep the rejection letter, policy schedule, proposal form, premium receipts, medical records, and claim papers, along with all correspondence with the insurer.
