The Fatehabad District Consumer Commission has mandated Cigna TTK Health Insurance to pay Rs 50 lakh to a widow after rejecting her late husband’s critical illness claim, citing inadequate investigation and service deficiencies.
The Fatehabad District Consumer Commission in Haryana has ordered Cigna TTK Health Insurance Company to pay Rs 50 lakh to a widow after rejecting a critical illness claim linked to her late husband’s heart ailment, saying the insurer’s handling of the case caused her financial loss, harassment and mental distress. The commission also awarded Rs 20,000 in litigation costs and held that the company had been deficient in service.
According to the order dated August 6, the man had bought a “Lifestyle Protection-Critical Care Basic” policy covering Rs 50 lakh and valid from September 27, 2018 to September 26, 2019. He was later admitted to Paras Hospital in Bhuna, Fatehabad, from November 24 to November 28, 2020 for a heart-related condition and filed a claim with the insurer. The company repudiated the claim on November 5, 2021, and its records later showed a further repudiation date of December 30, 2021, after his death on November 25, 2021.
The widow then pursued the claim herself, arguing that her husband had died of a condition covered under the policy and that she was entitled to the full insured amount. The insurer countered that the complaint was not maintainable, that required medical criteria for myocardial infarction had not been met and that missing documents and discrepancies suggested fabrication. The commission rejected that defence, saying the insurer had not proved fraud, a pre-existing condition or any basis to deny the claim.
The panel said any gap in the hospital records could not be blamed on the patient or his widow, because the insured person was not responsible for maintaining hospital documentation. It also found that the company had acted carelessly in rejecting the claim without properly checking the facts. The decision comes amid a series of consumer forum rulings in which insurers have been directed to honour disputed claims, including cases reported by The Indian Express and The Economic Times involving alleged non-disclosure, missing reports or other paperwork disputes. The wider pattern has reinforced the view that insurers must show solid evidence before refusing to pay policy benefits, particularly when families are left to carry the burden after a policyholder’s death.
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