Widow Wins Rs 50 Lakh After Insurer Wrongfully Denies Claim

The Fatehabad District Consumer Commission has directed Cigna TTK Health Insurance Company to pay Rs 50 lakh to the widow of a policyholder, whose critical illness claim was rejected. This decision, issued on August 6, 2026, also awarded Rs 20,000 for litigation costs, citing deficiency in service.

The commission found that the insurer repudiated the claim after the policyholder's death without justification. This action led to considerable monetary loss, harassment, and mental agony for the complainant, who had to incur litigation expenses to pursue the claim. The insurer's own records indicated the claim was repudiated on December 30, 2021, more than a month after the policyholder's death on November 25, 2021.

The policyholder had purchased a critical illness cover for Rs 50 lakh. After his death from heart disease, his widow pursued the claim, arguing it fell under the policy's critical illness coverage. The insurance company defended its decision by alleging non-fulfillment of medical criteria and discrepancies in records, suggesting fabrication.

However, the commission noted that the policy's critical illness coverage was undisputed. It held that any deficiencies in medical records were the hospital's responsibility, not the patient's or complainant's. The insurer failed to provide evidence of fraud or a pre-existing condition, reinforcing the decision against them. This judgment underscores that insurers must prove fraud or pre-existing conditions to deny critical illness claims.