Insurer rejected Rs 50 lakh claim after man’s death; consumer panel finds insurer at fault, orders full payout with 6% interest

A consumer commission in Haryana has directed Cigna TTK Health Insurance Company to pay Rs 50 lakh to a woman after finding that the insurer wrongly rejected her late husband’s critical illness insurance claim.

The Fatehabad District Consumer Disputes Redressal Commission, in its order dated August 6, 2026, also directed the insurer to pay 6% annual interest on the Rs 50 lakh amount from October 5, 2022, along with Rs 20,000 towards litigation costs.

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Man dies after being treated for heart problem

According to the commission’s order, Mange Ram had purchased a Cigna TTK health insurance policy called Lifestyle Protection-Critical Care Basic, which included coverage for critical illnesses up to Rs 50 lakh.

Mange Ram was admitted to Paras Hospital in Bhuna, Fatehabad, from November 24 to November 28, 2020, after suffering from a heart problem. He subsequently submitted a medical claim to the insurer, but the company rejected it on May 11, 2021.

Mange Ram died on November 25, 2021, due to heart disease.

Wife seeks Rs 50 lakh critical illness insurance claim

After her husband’s death, his wife Suman approached the insurer seeking payment under the critical illness cover. She also sent a legal notice to the company on September 6, 2022, asking it to settle the Rs 50 lakh claim.

However, the insurer did not make the payment, prompting Suman to approach the consumer commission. She alleged that the rejection of the claim was unjustified and had caused her financial hardship and mental harassment.

Insurer alleges discrepancies in medical records

Cigna TTK disputed the complaint and argued that Suman had not submitted all the documents required under the policy.

The insurer also alleged discrepancies in the medical records and suggested that the claim could involve fraud. It maintained that a claim for critical illness cover relating to a heart attack could only be paid if the specific conditions laid down in the policy were fulfilled and the required medical documents were provided.

Consumer panel says insurer failed to prove fraud

The commission, comprising President Gulab Singh and member O.P. Tuteja, noted that the insurance policy clearly provided coverage for critical illnesses.

The bench also found that Mange Ram had been hospitalised for a heart-related condition during the relevant period. It noted that the insurer’s own records established his hospitalisation and showed that its investigation team had collected his medical documents.

The commission said any discrepancy in hospital records could not automatically be attributed to the patient.

“The LA being the patient is not supposed to maintain the record of the hospital,” the commission observed.

Insurer could not prove medical records were fake

The commission noted that while Cigna TTK had alleged that the medical records contained discrepancies pointing towards fraud, it failed to produce convincing evidence that the documents had been fabricated.

It also found that the insurer had not established that Mange Ram did not suffer from a critical illness covered under the policy. His death due to heart disease was also considered relevant to the coverage claimed by his wife.

Claim rejected even after policyholder’s death

The commission took particular note of the fact that the insurer rejected the claim on December 30, 2021, in Mange Ram’s name, even though he had died on November 25, 2021.

“This fact on the record proves the OP repudiated the claim without applying mind and this act of OP is also an act of deficiency in service,” the commission said.

The bench concluded that the insurer had failed to properly consider Suman’s claim and had not settled it within a reasonable period after receiving her legal notice.

Cigna TTK ordered to pay Rs 50 lakh with interest

The Fatehabad consumer commission directed Cigna TTK Health Insurance Company to pay Suman Rs 50 lakh under the critical illness policy, along with 6% annual interest from October 5, 2022, until the date of the order.

The insurer was also ordered to pay Rs 20,000 towards litigation costs.

Cigna TTK has been given two months to comply with the order. If it fails to do so, the Rs 50 lakh claim, accrued interest and litigation costs will carry 7% annual interest from the date of the order until payment.