Complaint against wrongful repudiation of Group Death Claim & Mis-selling of Insurance Policy

kalpesh chaudhari

kalpesh chaudhari

New member
Policy Name
group death claim
Company Name
india first insurance company
Loss Amount
1800000
Ratings
1.00 star(s)
Opposite Party Address
manager rapc shop no 22 23 24 25 26 27 28 star world complex 54 green city road nr bagban circle bhatha surat 394510
Policy Details

  • Group Death Claim No: CNA0003723001
  • Policy No: G0001566
  • Member No: A3344
  • Life Assured: Mr. Rekha Raysinghbhai Chaudhari
  • Loan Account No: 93260600002160
  • Bank: Bank of Baroda
  • Insurance Company: IndiaFirst Life Insurance
  • Loan Date: 11-12-2023
  • Insurance Premium Paid: ₹1,07,100

Respected Sir/Madam,​

I hereby submit this complaint regarding the wrongful rejection (repudiation) of death claim and serious negligence by both bank and insurance officials.

1. Mis-selling of Insurance Policy​

At the time of housing loan sanction on 11-12-2023, bank and insurance employees informed us that:

  • Insurance premium must be paid with loan.
  • In case of borrower’s death, insurance company will pay the outstanding loan amount.
Based on this assurance, we paid a premium of ₹1,07,100.

However:

  • Policy terms and conditions were not explained.
  • Policy document was not provided at the branch.
  • Employees were focused only on achieving sales targets.

2. No Medical Examination Conducted​

  • No medical check-up of the insured person was conducted.
  • No health verification was properly explained or taken.
  • Insurance company accepted premium without medical assessment.
Therefore, rejecting claim later on health grounds is unfair and against insurance principles.

3. Policy Document Not Provided​

  • Insurance policy was not available at the branch.
  • I personally visited the branch on 11 December 2025.
  • Branch Manager only provided the mobile number of insurance employee.
  • Documents were submitted at RAPC Branch Bhatha, Surat, but no proper guidance or acknowledgment was given.

4. Lack of Communication​

  • Insurance company did not properly inform us regarding claim processing.
  • No clear explanation or counseling was given before rejecting the claim.
  • After claim rejection, only premium amount was credited back to account.
This action is misleading and causes financial loss and mental harassment.

5. Wrongful Claim Repudiation​

The claim has been rejected despite:

  • Premium accepted by insurer,
  • No medical examination conducted,
  • Customer relying on bank & insurer representation.
This amounts to:

  • Mis-selling,
  • Deficiency in service,
  • Unfair trade practice,
  • Violation of IRDAI customer protection guidelines.

RELIEF REQUESTED​

I request you to:

  1. Reconsider and approve the death claim immediately.
  2. Settle outstanding loan amount as per insurance coverage.
  3. Provide written reasons and underwriting documents used for rejection.
  4. Take action against concerned bank and insurance employees for mis-selling.
  5. Compensate for mental harassment and financial loss.

Enclosures​

  • Loan documents
  • Premium payment proof
  • Claim documents submitted
  • Repudiation letter copy
  • Identity documents
Applicant Name: Kalpesh Chaudhari
Address: Ten Nava Faliya, Ten Road, Bardoli, Gujarat
Mobile: 9727558395

Date: __________
Signature: __________
 
To,
The Grievance Redressal Officer
IndiaFirst Life Insurance Company Ltd.

Subject: Reply Against Wrong Allegation & Unjust Claim Rejection – Policy No. G0001566

Respected Sir/Madam,

This is with reference to your reply stating that the Life Insured was suffering from Chronic Kidney Disease (CKD) and was on Maintenance Hemodialysis prior to issuance of the policy and therefore the claim has been rejected.

I strongly deny and dispute your allegations for the following reasons:

  1. Failure of Insurance Company’s Duty at Policy Issuance
    At the time of selling the insurance policy, it was the responsibility of the insurance company and its authorized agent to properly assess the health condition of the customer.
    • No medical examination was conducted by the company.
    • No detailed health verification was carried out.
    • The policy was issued only for sales targets without proper underwriting.
  2. Non-Disclosure Cannot Be Alleged Without Proper Verification
    If the insured was allegedly suffering from CKD prior to policy issuance, the company should have conducted mandatory medical tests before approving the policy.
    Issuing the policy without medical check-up clearly proves negligence on the part of the insurer.
  3. Agent’s Responsibility & Mis-Selling
    The company’s agent explained only benefits of the policy and never informed about exclusions, medical disclosure consequences, or claim rejection conditions.
    The customer relied fully on the insurer and acted in good faith.
  4. Violation of Principles of Utmost Good Faith (Uberrima Fidei)
    Insurance contracts require honesty from both parties. The insurer cannot accept premium, issue policy, and later deny liability at claim stage without proper proof and medical underwriting.
  5. Cause of Death Not Properly Evaluated
    The insured’s death occurred due to Intracerebral Haemorrhage (ICH). The company has not provided authenticated medical records proving intentional suppression of illness at proposal stage.
  6. Unfair Trade Practice
    Collecting premium, issuing policy without medical examination, and rejecting claim later amounts to unfair trade practice and deficiency in service.
Therefore, I request you to:

  • Reconsider and approve the death claim immediately.
  • Provide certified copies of proposal form, medical underwriting report, and documents relied upon for repudiation.
  • Resolve this matter within 15 days from receipt of this letter.
Failing which, I shall be constrained to initiate legal proceedings before:

  • Insurance Ombudsman
  • Consumer Disputes Redressal Commission
  • IRDAI (Insurance Regulatory Authority of India)
without any further notice, at your risk, cost, and consequences.

Yours faithfully,
[Claimant Name]kalpesh chaudhari
[Address]ten nava faliya ten road bardoli
[Mobile Number]9727558395
[Email ID]kalpesh143d@gmail.com
 
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