Insurer Ordered to Pay Rs 2.24 Crore After Wrongly Rejecting NRI Doctor’s Death Claim
Death claim proceedings highlight the insurer’s liability after the rejection of an NRI doctor’s policy claim was challenged.
Death claim dispute ends with an insurer ordered to pay Rs 2.24 crore after rejecting an NRI doctor's claim.
Death Claim: A district consumer forum in Gujarat has ordered an insurance company to pay Rs 2.24 crore, along with 7% annual interest, to the mother of a US-based Indian doctor after ruling that the insurer wrongfully denied her life insurance claim by invoking an undocumented pre-existing liver condition.
The Navsari District Consumer Disputes Redressal Commission (CDRC) passed the order on August 31, closing out a nearly year-long dispute that began after the insurer refused to honour a policy taken out by Dr. Satyen Desai, an NRI physician practising in the United States, who died in May 2024 following a domestic accident.
Death Claim: The Claim: A Fatal Fall and a Rejected Policy
According to the case details, Dr. Desai purchased the insurance policy on November 29, 2022, paying an annual premium of approximately Rs 20.90 lakh. On May 15, 2024, he suffered a severe head injury after a fall at his home. He was rushed to INS Hospital, where doctors diagnosed intracranial and intraventricular haemorrhage — bleeding within and around the brain. Cirrhosis of the liver was noted in his medical records as a comorbidity, or contributing risk factor. Dr. Desai succumbed to his injuries four days later, on May 19.
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When his mother and policy nominee, Kalpana Desai, filed a claim, the insurer rejected it in November 2024. The company alleged that Dr. Desai had concealed a pre-existing liver ailment at the time of purchasing the policy, pointing to an investigation report that referenced a liver-related blood test he had undergone in April 2022. The insurer further contended that his death was ultimately caused by a heart attack linked to liver disease — not the fall. It also raised procedural objections, questioning why an NRI based in the US had bought an insurance policy in India, and why his mother, rather than family members residing in the US, had been named as the nominee.
Death Claim: No Proof, No Link: Commission Finds Insurer’s Case Falls Apart
Representing the complainant, advocate Nayan Vakil argued that the medical evidence unambiguously pointed to the brain haemorrhage caused by the fall as the cause of death, and that no document on record established either a pre-existing liver disease or a medical connection between such a condition and the fatal haemorrhage.
The CDRC agreed. In its order, the commission noted that the insurer had failed to furnish any laboratory report conclusively confirming a pre-existing liver disease, nor any expert medical opinion connecting such a condition to Dr. Desai’s death. It observed that the hospital’s death summary made no mention of liver disease as a cause of death, and that the documented medical trail consistently pointed to the head injury and resulting haemorrhage.
The commission was equally unpersuaded by the insurer’s objections to the policy structure. It found that Dr. Desai had clearly disclosed his NRI status on the original proposal form, and that policyholders are entitled to nominate any individual of their choosing. The commission also pointed out a procedural gap on the insurer’s part: for applicants above the age of 40 seeking coverage exceeding Rs 50 lakh, insurers are required to conduct medical examinations — yet the company could not produce any such medical reports to support its claims.
Death Claim: Insurer Directed to Pay Full Sum Assured With Interest
Concluding that the insurer had misread or misrepresented the available medical facts in an attempt to avoid settling a legitimate claim, the CDRC directed the company to pay Kalpana Desai the full sum of Rs 2.24 crore, along with 7% annual interest.
The ruling adds to a growing body of consumer forum orders across India that have pushed back against insurers rejecting high-value claims on the grounds of alleged non-disclosure, reinforcing that the burden of proof for such claims rests squarely with the insurance company — not the policyholder’s family.
