The District Consumer Commission in Telangana’s Nizamabad directed ICICI Prudential Life Insurance to pay Rs 8.52 lakh to the nominee-wife of a deceased policyholder after wrongly rejecting the claim citing pre-existing diseases, and noted that diabetes and hypertension had no proven link with the cause of death.

A bench of president Suvarna Jayasri and members I Nageswara Rao and Suma Vala held that diabetes and hypertension had no proven link with the cause of death, which was a heart attack, and awarded Rs 5,000 compensation and Rs 3,000 litigation cost.

“In the absence of clear and cogent evidence that the pre-existing disease played a material role in causing the death, the insurer cannot deny the claim on the grounds of nondisclosure or pre-existing conditions,” the court said on May 25.

The case originated from a complaint filed by the wife of the late Ambati Rajender, Sunanda, against Vastu Housing Finance Corporation Ltd and ICICI Prudential Life Insurance Company Ltd.

The man had taken a housing loan and obtained an ICICI Pru Super Protect Credit Insurance Policy through the finance company. The policy provided a death benefit of Rs 10 lakh, and his wife was the nominee.

A premium of Rs 26,906 was paid, and the policy was valid from April 1, 2023, to April 1, 2025. The man died on August 1, 2023, due to a heart attack, and immediately the matter was reported to the opposite parties, and material claim papers were submitted in the office through courier/registered post.

However, ICICI Prudential rejected the claim in September 2023, alleging that he had concealed pre-existing conditions such as hypertension, diabetes, fatty liver, and heart-related issues while taking the policy.

The wife argued that her husband had not hidden any health information, the insurer had accepted the proposal after medical checks, and the alleged disease had no connection with his cause of death. She alleged a deficiency in service and unfair rejection of the claim.

In hearing, the court noted that the Vastu Housing Finance Corporation Ltd had been absent and the ICICI Prudential Life Insurance Company Ltd set ex parte through a docket order.