Same trip, same loss: why was one insurance claim rejected?
My husband and I had to cut short our holiday abroad after he developed a severe allergic reaction to a prescribed antibiotic, causing extensive sunburn and photosensitivity. On medical advice, we returned to India earlier than planned and incurred additional expenses for rescheduling our flights. We both had separate travel insurance policies and filed trip curtailment claims. Surprisingly, while my husband’s claim was approved, mine was rejected. The insurer said my claim was not payable because there was no overseas hospitalisation for more than five consecutive days. Can two claims arising from the same incident be treated differently? What are my rights in such a situation?
Name withheld on request
The facts you’ve described raise an important issue regarding consistency in claim assessment. While every claim is evaluated independently, insurers are expected to apply identical policy provisions consistently when the underlying facts and circumstances are the same.
In your case, both claims arose from the same medical emergency during the same trip. The decision to curtail the journey was driven by your husband’s medical condition, and both of you incurred identical financial losses because of the early return. If one claim has been admitted under the same policy conditions, rejecting the other based on a different interpretation of the same clause warrants a closer examination.
The insurer has relied upon a policy condition requiring overseas hospitalisation for a specified period before a trip curtailment benefit becomes payable. However, policy conditions cannot be interpreted in isolation. They must be read in the context of the objective of the cover and the facts of the case.
One important observation in this matter was that the insured persons returned to India specifically to prevent the medical condition from worsening and to receive appropriate treatment. Waiting for the condition to deteriorate to the point of requiring prolonged hospitalisation would have defeated the very purpose of taking timely medical advice. Insurance is intended to indemnify genuine financial losses arising from covered contingencies and should not encourage actions that may aggravate a medical condition merely to satisfy a technical requirement.
The Insurance Regulatory and Development Authority of India (Irdai) has consistently emphasised that insurers should adopt fair, transparent and objective claims practices. Under the IRDAI (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024, insurers are expected to process claims fairly, communicate clear reasons for repudiation, and ensure that policy terms are applied consistently and in good faith. While these regulations do not direct insurers to approve every claim, they do require decisions to be reasoned, non-arbitrary and based on the policy contract.
In situations where two insured individuals are affected by the same insured event but receive contradictory decisions, it is reasonable to seek clarification based on such differential treatment. An insurer should be able to explain why identical facts have resulted in different outcomes, particularly when the claim documents, medical evidence and financial losses are substantially similar.
It is recommended that you write to the insurer’s grievance redressal officer (GRO) to reconsider the claim by applying the policy uniformly and considering the overall intent of the trip curtailment benefit rather than relying solely on a restrictive interpretation of one clause. This should help you get your claim.
If the matter remains unresolved, it may be escalated before the Bima Bharosa (Irdai), Insurance Ombudsman or consumer forums, depending on the facts of the case.
