A.P. Sahi, President

Heard Mr. Sawhney, learned counsel for the petitioners and Ms. Anubha Agrawal, learned amicus curiae for the respondent. The contention is that the insured late Mr. Nabi Ahmed, who had taken a Life Insurance Double Accident Benefit Policy, was suffering from serious diseases, which facts were not disclosed by him, while seeking revival of the policy that had already lapsed. This suppression was therefore uncovered and the claim was repudiated after his death that was raised by his sister, the respondent/ complainant herein. The repudiation letter dated 20.09.2013 categorically records that as on the date of filling up of the declaration form for the revival of the policy that is 23.12.2012, the insured had given a false declaration in respect of the queries raised in question no. 2, whereas in fact he was suffering not only from Tuberculosis as reported in October 2012, but also from Cancer as per the medical report dated 02.11.2012. Mr. Sawhney urged that these documents remained uncontroverted, yet the District Commission and the State Commission proceeded to allow the complaint only on the ground that the petitioner Corporation had failed to get the medical tests carried out at the time of the revival of the policy. The impugned orders record that since this was a deficiency on the part of the Insurance Company, the repudiation was invalid and the claim was indemnifiable.

2. Mr. Sawhney submits that the said approach is absolutely incorrect and illegal, in as much as the revival of the policy was based on the declaration which is evidently false declaration and therefore in view of the various decisions of the Apex Court and this Commission, the impugned orders are liable to be set aside. He has cited the following five decisions in support of his submissions:

                   1. Budhiben Pababhai Vs. LIC of India & Ors., I (2010) CPJ 92 (NC)

                   2. LIC of India Vs Raj Vilas Dongre, II (2020) CPJ 455 (NC)

                   3. Pankaj Parashar Vs. ICICI Prudential Life Insurance Co. Ltd., 2017 (2) CRP 23

                   4. Life Insurance Corporation of India Vs. Illa Rajaiah, MANU/CF/ 0768/2023

                   5. Sushila Singh Vs. Birla Sun Life Insurance, 2023 (4) CPR 235

3. Particularly, last two decisions which have been rendered in cases of false declaration at the time of the revival of the policy.

4. In the present case it is disputed that the policy was taken in the year 2008. However, no premium was paid for the year 2009 and 2010 as well as 2011 and with this default the policy stood lapsed. However the insured moved an application for revival and it is in the said context that the declaration form was filled up on 23.12.2012. It is undisputed that the questions therein were answered in the negative by the insured.

5. However, learned amicus curiae on behalf of the respondent/ complainant, Ms. Anubha Agrawal urged that the insured had signed in Hindi and even otherwise the form appears to have not been filled up by him and hence the filling up of the form by itself cannot amount to a false declaration so as to disentitle the claimants from receiving indemnification.

6. We are unable to accept the contention raised on behalf of the respondent keeping in view the law laid down by the Apex Court in the case of Reliance Life Insurance Company Limited & Anr. Vs. Rekhaben Nareshbhai Rathod, (2019) 6 SCC 175. We may further point that the learned counsel for the petitioner has rightly invited the attention of the Bench to the decisions where said declarations at the stage of revival of the policy were taken into consideration and it was held that false declaration at the time of revival would also amount to a breach of the terms of the policy and consequently the Insurance Corporation would be justified in repudiating the claim. We see no reason to differ from the said view expressed in the decisions cited at the bar by the learned counsel for the petitioner and we therefore find that both the fora below have materially erred by not following the correct propounded law as referred to above.

7. The findings recorded by the fora below that it was the obligation of the Insurance Company to have got a medical check-up conducted, overlooks the fact that the policy was not a medical insurance policy, but was rather a life insurance policy, where the declaration has to be made by the insured correctly, including about their medical health status. In the instant case the insured was not only suffering from Tuberculosis, but also from Cancer and the same stood substantiated by the medical reports which are on records. The ultrasonography dated 02.11.2012 and the other medical reports are all prior to the date of filling up of the declaration from. Thus, these facts were well within the knowledge of the insured, who suppressed the same and in such circumstances the contention raised on behalf of the petitioner that there is a wrong disclosure is correct and supported by law. The Insurance Company had discharged its burden to satisfy suppression as per the law enumerated by the Apex Court in the case of Mahakali Suiatha Vs. Future Generali India Life Insurance Co. Ltd, 2024 (8) SCC 712, Para 41 to 46.

8. We therefore find the impugned orders to be unsustainable. We therefore allow the revision petition by setting aside the findings recorded by the fora below, but at the same time keeping in view the small amount of Rs.1,00,000/- that has been claimed, that too even by somebody who has had to take the help of an amicus curiae and not being able to contest this petition, we permit the payment of Rs.1,00,000/-, which is the amount under the policy as a special case on the peculiar facts without any interest.

9. The compensation of Rs.5,000/- and costs of Rs.3,000/- are set aside.

10. The passing of our order for retention of the of Rs.1,00,000/- with the complainant would not be a precedent for any other case. Accordingly, the revision petition is allowed to the extent indicated above. The learned amicus curiae shall be entitled to receive the remuneration payable by this Commission.