Practical Case Study Bank

5 real-world insurance case studies with detailed analysis

Product:

Outcome:

Hydrostatic Lock Claim Rejection — Mumbai Floods

Mr. Anil Mehta owned a Honda City insured with Comprehensive Motor Insurance (IDV: ₹8.5 Lakhs). During the July 2023 Mumbai floods, his car was submerged in 3 feet of water in the office parking basement.

3 dispute points·Claim Rejected

Partial SettlementHealth Insurance

Pre-Existing Disease Non-Disclosure — Health Claim Dispute

Mrs. Sunita Verma (52 years) purchased an individual health insurance policy with ₹10 Lakh sum insured from Star Health in 2021. She had been diagnosed with Type 2 Diabetes in 2018 but did not disclose it in the proposal form.

4 dispute points·Partial Settlement

Partial SettlementFire Insurance

Under-Insurance — Average Clause Reduces Claim by 60%

M/s Rajdhani Textiles, a garment manufacturer in Surat, had a fire insurance policy with Sum Insured of ₹40 Lakhs. However, the actual value of stock and machinery at the premises was ₹1 Crore (₹100 Lakhs).

3 dispute points·Partial Settlement

Claim AcceptedMotor Insurance

Third-Party Claim Paid Despite Drunk Driving

Mr. Ravi Kumar was driving under the influence of alcohol and hit a pedestrian, Mr. Shankar, causing serious injuries. Mr. Shankar filed a claim under the Motor Vehicles Act.

3 dispute points·Claim Accepted

Partial SettlementHealth Insurance

Room Rent Sub-Limit Reduces Total Claim by 45%

Mr. Prakash Iyer (40 years) had a health insurance policy with ₹5 Lakh sum insured. The policy had a room rent sub-limit of 1% of SI (₹5,000/day). He was hospitalized for a knee replacement surgery.

3 dispute points·Partial Settlement