Lack Of Efforts By Insured To Review Policy Terms, Maharashtra State Commission Allows Appeal Filed By ICICI Lombard Insurance Co.

The State Consumer Disputes Redressal Commission, Maharashtra bench led by Dr. Satish A. Munde and V.C. Premchandani, overturned a District Commission ruling in favor of ICICI Lombard General Insurance Company.

They found that the Insurance Company had properly settled the medical claim of the Complainant, a Mumbai-based Advocate, based on the agreed policy terms. Despite the Complainant's Bilateral Inguinal Hernia diagnosis necessitating hospitalization and surgery, the Insurance Company adhered to policy provisions limiting coverage for such surgeries.

The State Commission noted that the Complainant failed to respond to the insurer's invitation to review and contest policy terms, thereby affirming the validity of the policy's conditions. Consequently, the State Commission allowed the appeal, setting aside the District Commission's order.