sanjay1980
New member
- Policy Name
- 4010/233082484/00/000
- Company Name
- ICICI Lombard General Insurance Company Limited
- Customer Care Number
- 18002666
- Loss Amount
- 439841
- Ratings
- Opposite Party Address
- 404 3 - A Shivaalik Park Complex Sonale Road Bhadwad Bhiwandi Thane - 421302
The Complainant, Sanjay Maurya (M/s. Sony Textiles), purchased a valid Workman Compensation Insurance Policy from ICICI Lombard (Policy No. 4010/233082484/00/000) covering 01-12-2021 to 30-11-2022.
On 29-07-2022, employee Madhu Jain suffered serious injury during working hours while retrieving official files, resulting in temporary total disability.
The complainant paid all related medical expenses and submitted a proper claim with supporting documents, including the employee’s No Objection Certificate.
The Respondent rejected the claim, alleging the accident did not arise out of and in the course of employment, without offering concrete proof.
Despite repeated explanations and an appeal to the Insurance Ombudsman in August 2024, the claim was again unjustly denied.
The rejection ignored facts: the injury happened during duty hours while performing assigned work, qualifying for coverage under the policy and Workers' Compensation Act.
Due to this denial, the complainant suffered significant financial loss, emotional distress, and burden of medical expenses already paid.
The Respondent’s conduct amounts to unfair trade practice and deficiency in service.
The complainant now seeks: ₹4,39,841/- claim amount, interest @9% p.a., compensation for financial loss and mental agony, and legal costs — total ₹10,39,602/-.
The complaint is within limitation and under jurisdiction of the Central Bombay Consumer Court as claim was processed through the respondent’s Mumbai office.
The complainant prays for just relief to protect employee rights and ensure fair insurance practice.
On 29-07-2022, employee Madhu Jain suffered serious injury during working hours while retrieving official files, resulting in temporary total disability.
The complainant paid all related medical expenses and submitted a proper claim with supporting documents, including the employee’s No Objection Certificate.
The Respondent rejected the claim, alleging the accident did not arise out of and in the course of employment, without offering concrete proof.
Despite repeated explanations and an appeal to the Insurance Ombudsman in August 2024, the claim was again unjustly denied.
The rejection ignored facts: the injury happened during duty hours while performing assigned work, qualifying for coverage under the policy and Workers' Compensation Act.
Due to this denial, the complainant suffered significant financial loss, emotional distress, and burden of medical expenses already paid.
The Respondent’s conduct amounts to unfair trade practice and deficiency in service.
The complainant now seeks: ₹4,39,841/- claim amount, interest @9% p.a., compensation for financial loss and mental agony, and legal costs — total ₹10,39,602/-.
The complaint is within limitation and under jurisdiction of the Central Bombay Consumer Court as claim was processed through the respondent’s Mumbai office.
The complainant prays for just relief to protect employee rights and ensure fair insurance practice.
