Can an insurer reject a claim even after a genuine fire loss? - Okube Advisors LLP
Business Insurance August 03, 2026 By oorjita 0 Comments

Can an insurer reject a claim even after a genuine fire loss?

A March 2026 Supreme Court judgment provides an important perspective on how insurance claims are assessed. In United India Insurance Co. Ltd. v. Sayona Colors Pvt. Ltd., the Court set aside an NCDRC order that had directed the insurer to pay over ₹3.33 crore. While the fire itself was undisputed, the Court held that the claim was vitiated by fraud and therefore not payable. The decision was based on a combination of forensic evidence, the surveyor’s report, and investigation findings. The Court noted the presence of kerosene at the origin of the fire, the absence of evidence supporting an electrical short circuit, discrepancies in supplier records, fabricated invoices, and manipulation of accounts. These factors collectively led the Court to conclude that the claim was not genuine. A key takeaway from the judgment is that the assessment of physical loss and the admissibility of an insurance claim are two distinct issues. Even if a surveyor quantifies the extent of damage, the insurer is not liable if the claim itself is found to be fraudulent. The Court also reiterated the well-established legal principle that fraud vitiates all transactions. Once fraud is established, there is no scope for granting partial or equitable relief under the insurance policy. The Court further directed the constitution of a Special Investigation Team to investigate the alleged fraud.

For insurers, corporates, brokers, and risk professionals, this judgment highlights the importance of thorough investigations, robust documentation, and evidence-based claim assessment. It also reinforces that the integrity of the insurance system depends on protecting genuine claims while identifying and rejecting fraudulent ones.

The rise of the “Boss Scam” and what organisations should know.

Trust has become one of the most exploited vulnerabilities in cybersecurity. The Ministry of Home Affairs has recently warned organisations about the rise of the “Boss Scam”, a form of cyber fraud where criminals impersonate CEOs, senior executives, regulators, or government officials to manipulate employees into transferring funds or sharing sensitive information. This threat is very real. Recently, former Rajya Sabha MP Naresh Gujral, son of former Prime Minister I.K. Gujral, reportedly lost ₹7.8 crore after cyber fraudsters impersonated him on WhatsApp and convinced his company’s CFO to transfer funds to multiple accounts. The attack did not rely on sophisticated hacking tools. It relied on something far more powerful: authority, urgency, and trust

A typical Boss Scam follows a simple pattern:

  • A message arrives from what appears to be a senior executive, regulator, or government authority.
  • The request is marked urgent and confidential.
  • Employees are pressured to act quickly without verification.
  • Funds are transferred or sensitive information is shared.
  • The fraud is discovered only after the damage is done.

Many organisations invest heavily in technology but underestimate the human element of cybersecurity. The strongest firewall in the world cannot stop an employee from acting on instructions they believe came from the CEO. In today’s threat landscape, “Verify Before You Act” may be one of the most effective cybersecurity controls an organisation can implement.

MARKET PULSE

82.88%

According to Irdai, the non-life insurance industry’s overall ICR stood at 82.88 per cent in 2024–25. The Incurred Claim Ratio, or ICR, is the share of premium income that an insurer pays back to policyholders as claims in a given year. An ICR of 82.88% means the industry paid out roughly ₹83 in claims for every ₹100 collected in premium. Anything between 70% and 90% is considered healthy: low enough for the insurer to remain financially stable, high enough to show that claims are actually being paid.

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