Pune: The Pune Additional District Consumer Grievance Redressal Commission has directed ICICI Lombard General Insurance Company to compensate a Shirur resident with Rs 10.46 lakh after the insurer wrongly denied a valid accident claim. The Commission, chaired by Dr. Arun Gaikwad along with members Pranali Sawant and Kanchan Gangadhar, condemned the insurer’s refusal as “improper and illegal.”
The Commission ruled firmly that an insurance company cannot refuse a claim based on assumptions, doubts, or speculation—such as questioning whether the complainant and his child were injured—especially when there is clear evidence of severe vehicle damage. ICICI Lombard was also ordered to pay 9% annual interest on the claim amount from the date the claim was rejected, along with Rs 45,000 to cover mental and physical distress as well as legal fees.
Rajendra Bothra, the complainant, filed the case against ICICI Lombard and Bank of Baroda, which held a mortgage on the accident vehicle. On June 8, 2021, while travelling with his family near Kamargaon on the Pune highway, Bothra’s vehicle suffered a tyre burst on the right side, causing a serious accident. Bothra and his child sustained minor injuries, protected by airbags, while his wife and daughter were seriously injured, and a relative suffered a fractured leg.
Although the insurance policy was valid at the time of the accident, ICICI Lombard rejected the claim, alleging misrepresentation about the driver’s identity and highlighting the absence of a First Information Report (FIR). They also cited a technical report that cast doubt on how Bothra and his child could escape injury in such a severe crash. The Commission, however, dismissed these arguments as speculative and not supported by evidence.
Represented by Advocate Anil Satpute, Bothra challenged the denial before the Commission. The insurer maintained that Bothra was not driving at the time and pointed to discrepancies in his account along with the missing FIR. The Commission clarified that neither the delay in filing a report nor the lack of an FIR justified rejecting the claim. It underscored that the insurer has the burden of proof, which ICICI Lombard failed to meet.
Additionally, the Commission issued an ex-parte order against Bank of Baroda for not appearing despite being notified.
In conclusion, the Commission stated, “Rejecting the claim on the basis of assumptions and lack of FIR is unjustified. Such conduct by the insurer is illegal and inappropriate.”
Key Points:
ICICI Lombard ordered to pay Rs 10.46 lakh plus 9% interest annually from claim rejection date
Rs 45,000 awarded for Bothra’s mental and physical suffering and legal expenses
FIR not mandatory for claim approval, clarified the Commission
Claim rejection based on “possibility and doubt” ruled invalid
