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CDJ 2026 (Cons.) Case No.010 print Preview print print
Court : National Consumer Disputes Redressal Commission (NCDRC)
Case No : Second Appeal No. 440 of 2025
Judges: THE HONOURABLE DR. INDER JIT SINGH, PRESIDING MEMBER & THE HONOURABLE MR. JUSTICE SUDHIR KUMAR JAIN, MEMBER
Parties : Rajkumari Patel & Others Versus ICICI Prudential Life Insurance Company Limited & Others
Appearing Advocates : For the Appellants: R.K Bhawnani, Anis Ur Rahman, Advocates. For the Respondents: R1, Subham Bharambe, Advocate (VC), R2, Akansha Singh, Advocate (VC).
Date of Judgment : 04-12-2025
Head Note :-
Consumer Protection Act, 2019 - Section 51(2) -
Judgment :-

Sudhir Kumar Jain, Member

Briefly stated relevant facts as per the complaint are that Late Jagdish Patel (hereinafter referred to as 'the insured') who was husband of the appellant no.1/the complainant no.1/Rajkumari Patel and father of the appellants no 2 to 5/the complainants no 2 to 5 (hereinafter referred to as 'the appellants') took a loan of Rs. 30,00,000/- from the respondent no. 2/the opposite party no. 2/Chola Mandalam Investment & Finance Company Limited (hereinafter referred to as 'the respondent no 2') during his lifetime vide loan account number HE01DHT00000030231. The insured to secure the said loan procured insurance policy bearing policy number 61249366 with coverage period from 03.09.2022 to 03.09.2025 from the respondent no1/opposite party no1/ICICI Prudential Life Insurance Company Limited (hereinafter referred to as 'the respondent no 1') through the respondent no. 2. The insured paid single premium amounting to Rs.54,757/- with ICICI Pru Policy No D-6690809. The insured during the subsistence of the policy passed away on 17.02.2023 due to brain haemorrhage. The outstanding loan amount was to be paid by the respondent no 1 to the respondent no 2 as per terms and conditions of the insurance policy. The appellant no 1 after demise of the insured submitted insurance claim to the respondent no 1 for payment of the balance loan amount to the respondent no. 2. The respondent no. 1 vide letter dated 30.06.2023 repudiated the claim of the appellant no. 1 without valid justification. The respondent no. 2 did not take any appropriate action against the respondent no. 1 for wrongful repudiation of the claim which constituted gross negligence as the insurance policy was arranged through the respondent no. 2 from the respondent no. 1. The respondent no. 2 even after the death of the insured collected two monthly instalments from the appellants and the outstanding loan amount as on 10.08.2023 was Rs.31,10,054/-. The respondent no 2 sent a legal notice dated 10.07.2023 to the appellants on 07.11.2023 for recovery of outstanding loan amount which amounts to deficiency in service on the part of the respondents. The appellants being aggrieved filed the present consumer complaint bearing no CC/23/64 titled as Ralkumari & others vs. ICICI Prudential Life Insurance Company Limited & another before the District Consumer Disputes Redressal Commission, Dhamtari (hereinafter referred to as 'the District Forum') wherein prayed that the outstanding loan amount be paid besides payment of compensation and litigation expenses.

2. The respondent no. 1 filed reply before the District Forum wherein denied averments as stated in the complaint. The respondent no 1 stated that the respondent no 1 received Member Consent Form dated 30.09.2022 from the insured in respect of the Group Insurance Policy known as ICICI Pru Super Protect Credit for a single premium of Rs. 54,757. The respondent no 1 based on information provided in the Member Consent Form issued a Group Policy bearing Member ID number D6690809 on 14.10.2022 in favour of insured and the respondent no 2 was policy holder. The appellant no 1 was named as nominee. The respondent no 1 received Claimant Statement Forum on 25.04.2023 whereby it was informed that the insured had expired on 17.02.2023 due to brain haemorrhage. The insured has died within 04 months from date of issuance of policy and as such subject policy had fallen in the category of an Early Claim. The respondent no 1 due to this reason has conducted claim investigation to verify the genuineness of the claim. It was revealed during investigation that the insured was admitted in NHMMI Narayana Multispecialty Hospital on 25.03.2019 and had undergone percutaneous transluminal coronary angioplasty (PTCA) to left anterior descending artery. The insured was also a known case of hypertension. The respondent no 1 was constrained to repudiate claim of the appellants due to misrepresentation of material information which was communicated to the appellant no 1 vide letter dated 30.06.2023 and the premium amount was refunded to the appellants on 11.07.2023. It was prayed that the complaint be dismissed.

3. The respondent no. 2 also filed reply before the District Forum wherein submitted that the insured at the time of availing the loan facility after due consideration and deliberation voluntarily opted to obtain insurance coverage from the respondent no 1 which was specifically designed for loan protection. The respondent no 1 upon the death of the insured was liable to pay the outstanding loan amount to the respondent no 2 in accordance with the terms and conditions of the insurance policy. The respondent no. 2 was not privy and conversant with the terms and conditions stipulated in the insurance contract executed between the insured and the respondent no 1. The respondent no. 2 subsequent to the demise of the insured due to the non-payment of the loan amount issued a demand notice in exercise of its legal rights and in discharge of its statutory obligations. The respondent no. 2 after settlement of the insurance claim by the respondent no 1 is entitled to receive the insurance proceeds as the beneficiary under the loan protection policy. The respondent no 2 prayed that the complaint be summarily dismissed against the respondent no 2 being wholly unnecessary, false, fabricated, frivolous, vexatious, and devoid of merit.

4. The District Forum vide order dated 03.05.2024 partially allowed the complaint and observed that the respondents did not produce any document which can prove that the insured had died due to ailment of hypertension. The respondent no 1 is guilty of deficiency in service. The appellants suffered severe financial and mental pain due to non-release of insured amount. The relevant portion of the order dated 03.05.2024 is reproduced as under verbatim:

                        9) In the light of the above considered points, this Commission comes to the conclusion that the opposite parties have committed inferiority in service. Therefore, the complaint of the complainant is partially accepted and the following order is passed:-

                        (1) Opposite party No. 1 should adjust the premium amount of Rs.54,757/- (Rupees fifty-four thousand seven hundred and fiftyseven) within a period of 45 days after the date of death of the insured and pay the remaining loan amount to opposite party No.2.

                        (2) Opposite party no. 2 should return to the complainants the amount of two monthly instalments received from the complainants after the death of the insured within a period of 45 days.

                        (3) Opposite party no. 1 should also pay Rs.20,000/- (twenty thousand rupees) to the complainant for mental agony within the said period of 45 days.

                        (4) The opposite party No. 1 should also pay Rs.3,000/- (Three thousand rupees) separately to the complainants towards the litigation expenses within the said period of 45 days.

                        (10) As mandated by the Consumer Protection Act 1986/2019, a copy of this decision should be supplied free of cost to all the parties. The decisions will be uploaded immediately on the Commission's website for perusal of the parties. (Extracted from translated copy)

5. The respondents no 1 & 2 being aggrieved by the order dated 03.05.2024 passed by the District Form filed appeal bearing no 2024/415 titled as. Cholamandalam Investment & Finance Company Limited vs. Rajkumari Patel & others and appeal bearing no 2024/606 titled as ICICI Prudential Life Insurance Company Limited vs. Rajkumari Patel & others respectively before the Chhattisgarh State Consumer Disputes Redressal Commission, Pandari, Raipur (hereinafter referred to 'the State Commission'). The State Commission vide order dated 07.05.2025 (hereinafter referred as 'the impugned order') allowed both the appeals and set aside the order dated 03.05.2024 passed by the District Forum. The State Commission observed that insured before taking the policy was admitted in NHMMI Narayana Hospital between 25.03.2019 to 03.04.2019 and was suffering from heart disease and hypertension. The insurance claim was cancelled due to concealment of facts. The State Commission held that insured purchased the policy by hiding important and material facts regarding his illness which was in violation of terms of policy and there was no deficiency in service on part of the respondent no 1.

6. The appellants being aggrieved filed the present second appeals bearing no 440 of 2025 titled as Rajkumari Patel & others V ICICI Prudential Life Insurance Company Limited & another and bearing no 441 of 2025 titled as Rajkumari Patel & others V ICICI Prudential Life Insurance Company Limited & another under section 51(2) of the Consumer Protection Act, 2019 (hereinafter referred to as 'the Act') to challenge the impugned order primarily on grounds that the impugned order is bad and is against facts and law. The State Commission has failed to appreciate material on record. The State Commission in impugned order has overlooked detailed observations made by the District Forum. The State Commission passed the impugned order without going through the medical records. The insured had died because of brain hemorrhage. The State Commission on basis of presumption wrongly concluded that the insured gave incorrect information about his medical history. The appellants also challenged the impugned order on various other grounds and prayed that the second appeals be allowed and the impugned order be set aside. The appellants also mentioned substantial questions of law in memo of appeals. The appeals bearing no 440/2025 and 441/2025 are proposed to be decided by this order as based on similar questions of facts and law.

7. We have heard Sh. R.K Bhawnani and Sh. Anis Ur Rahman, Advocates for the appellants and Mr. Subham Bharambe, Advocate for respondent no 1 and Ms.Akansha Singh, Advocate for respondent no. 2. We have also considered the relevant records including the order passed by the District Forum and the impugned order passed by the State Commission.

8. The counsels for the appellants besides referring factual background of the case stated that the insured had availed loan of Rs.30,00,000/- from respondent no. 2 vide loan account bearing number HE01DHT00000030231and procured an insurance policy bearing no 61249366 for the security of loan from the respondent no. 1 through respondent no. 2 which was valid from 30.09.2022 to 30.09.2025 and a single premium of Rs.54,757/- was paid. The counsels for the appellants further stated that the insured had expired on 17.02.2023 due to brain haemorrhage during the subsistence of the policy period. The respondent no 1 as per the terms and conditions of the insurance policy has to discharge outstanding loan in favour of the respondent no. 2. It was argued that the appellant no 1 after the demise of the insured lodged a claim before respondent no. 1 for the payment of the outstanding loan amount but the respondent no 1vide letter dated 30.06.2023 repudiated the insurance claim of appellant no. 1. The respondent no. 2 even after the death of the insured recovered two monthly instalments from the appellants. The outstanding amount as on 10.08.2023 was Rs.31,10,054/- and the respondent no 2 also issued a demand notice on 7.11.2023. The counsels emphatically argued that the State Commission has erred while observing that the insured has supressed the material facts and there was no document before the State Commission to establish that insured has died due to angioplasty and hypertension. The State Commission has overlooked the observation given by the District Forum that the insured has died due to brain haemorrhage. It was further argued that insured did not conceal the material information from the respondent no 1 at time of procuring policy. The counsels for the appellants ultimately argued that acts and omissions on the part of the respondents constituted gross deficiency in service. The counsels for the appellants relied on decisions delivered by this Commission in HDFC Standard Life Insurance Company Limited vs. Virpal Nagar, First Appeal No. 855 of 2019Reliance Life Insurance Company Limited & another V Tarun Kumar Sudhir Halder, Revision Petition No. 2097 of 2017Neelam Chopra V Life Insurance Corporation of India, Revision Petition No. 4461 of 2012. The decision in Hari Om Agarwal V. Oriental Insurance Co. Ltd., W.P.(c) No. 656 of 2007 dated 17.09.2007 by Delhi High Court was also referred.

9. The counsel for the respondent no 1 argued that the respondent no 1 received Member Consent Form dated 30.09.2022 from the insured through Master Policy Holder i.e. the respondent no 2 on 07.10.2022 along with single premium of Rs. 54,757/- and the respondent no 1 based on declaration in Master Consent Form issued the subject Member Policy bearing no D6690809 for sum assured of Rs. 30,00,000/- on 14.10.2022. The appellant no 1 on 17.02.2023 submitted claimant statement form (Death Claim) to the respondent no 1 whereby death of insured on 17.02.2023 due to Brain Hemorrhage was informed. The respondent no 1 conducted detailed investigation to verify authenticity of claim as per section 45 of the Insurance Act, 1938 and it was found that the insured had previously undergone Percutaneous Trans-Luminal Coronary Angiography (PTCA) on his Left Anterior Descending Artery in NHMMI Narayana Multispecialty Hospital, Raipur. The insured was found to be known case of Hypertension as reflected from Discharge Summary dated 25.03.2019. It was argued that the insured did not disclose his medical history in Member Consent Form and medical documents were also referred. The counsel for the respondent no 1 argued that insurance contracts are founded on principles of good faith and proposer is required to disclose all relevant facts. The insured did not disclose his true medical condition for correct evaluation of risk on the life and to arrive at a decision regarding issuance of policy. The counsel for the respondent no 1 emphatically argued that the respondent no 1 correctly voided the policy vide letter dated 30.06.2023. The counsel for the respondent also countered the arguments advanced by the counsels of the appellants. The counsel for the respondent no 1 relied on HDFC Standard Life Insurance Co. Ltd. V Debashish Sanyal, 2020 SCC Online NCDRC 23Shrikant Murlidhar Ante V TJC of India. (2013) 3 CPJ 536 (NC)LIC V Hema Agarwal, 2023 SCC OnLine NCDRC 2031Reliance Life Insurance Company Limited V Rekhaben Nareshbhai Rathod (2019) 6 SCC 175Life Insurance Corporation of India V Kuldeep Singh, 2015 SCC OnLine NCDRC 2452Shriram Life Insurance Company Limited V E. Bhagyamma, 2019 SCC OnLine NCDRC 1043ICICI Prudential Life Insurance Company Limited V Yashika, 2015 SCC OnLine NCDRC 3111Life Insurance Corporation of India V Kusum Patro, (2012) 2 CPJ 272 (NC)LIC V Sunita, (2022) 1 SCC 68P.C. Chacko V LIC of India (2008) 1 SCC 321Vikram Greentech (1) Limited V New India Assurance Company Limited, (2009) 5 SCC 599 and Bajaj Allianz Life Insurance Company Limited V Dalbir Kaur, (2021) 13 SCC 553.

10. The counsel for the respondent no 2 argued that the insured deliberately procured insured policy from the respondent no 1 at the time of obtaining loan from respondent no. 2 for the security of the loan. The outstanding loan amount in the event of the death of the insured during the validity period of the policy was to be paid as per terms of this insurance policy by respondent no 1 to the respondent no 2. It was further argued that the respondent no 2 was not a privy to the terms and conditions of the insurance agreement executed between the insured and respondent no 1. The respondent no 2 after demise of the insured was constrained to issue a demand notice due to non-payment of loan amount. The respondent no 2 after acceptance of the insurance claim by respondent no is entitled to receive insurance amount directly as the beneficiary under the loan security arrangement. The respondent no. 2 denies any deficiency in service on its part.

11. It is reflecting from record that the insured was husband of the appellant no. 1 and father of the appellants no 2 to 5. The insured took loan of Rs. 30,00,000/- from the respondent no. 2 vide loan account number HE01DHT00000030231. The insured procured insurance policy bearing no 61249366 with coverage period from 03.09.2022 to 03.09.2025 from the respondent no 1 through the respondent no. 2 to secure the loan. The insured during validity of policy expired on on 17.02.2023 due to brain haemorrhage. The appellant no 1 after demise of the insured submitted insurance claim to the respondent no 1 for payment of outstanding loan amount to the respondent no. 2. The respondent no 1 has conducted claim investigation to verify the genuineness of the claim and investigation revealed that the insured was admitted in NHMMI Narayana Multispecialty Hospital on 25.03.2019 till 03.04.2019 and had undergone percutaneous transluminal coronary angioplasty (PTCA) to left anterior descending artery. The insured was also a known case of hypertension. The respondent no. 1 repudiated the claim of the appellant no. 1 vide letter dated 30.06.2023 due to misrepresentation of material information. The respondent no 1 has refunded premium amount to the appellants on 11.07.2023. The District Forum vide order dated 03.05.2024 partially allowed the complaint by observing that the respondents could not produce any document to prove that the insured had died due to hypertension. The respondent no 1 was held to be guilty of deficiency in service. The State Commission vide impugned order set aside the order dated 03.05.2024 passed by the District Forum and observed that insured before taking the policy was admitted in NHMMI Narayana Hospital and was suffering from heart disease and hypertension. The State Commission held that insured purchased the policy by hiding important and material facts regarding his illness in violation of terms of policy and there was no deficiency in service on part of the respondent no 1.

12. The doctrine of uberrima fides is the basic principle of insurance which postulates that there must be complete good faith on the part of the insured. The relationship between an insurer and the insured is founded on mutual obligations of trust and good faith. The Supreme Court in Life Insurance Corporation of India V GM Channabasamma, (1991) 1 SCC 357 observed that it is well settled that a contract of insurance is contract uberrima fides and there must be complete good faith on the part of the assured. The assured is thus under a solemn obligation to make full disclosure of material facts which may be relevant for the insurer to take into account while deciding whether the proposal should be accepted or not. The Supreme Court in United India Insurance Company Limited V M.K.J. Corporation, 1996 (6) SCC 428 underlined relevance of principle of uberrima fides and observed as under:-

It is a fundamental principle of Insurance law that utmost good faith must be observed by the contracting parties. Good faith forbids either party from concealing (non-disclosure) what he privately knows, to draw the other into a bargain, from his ignorance of that fact and his believing the contrary. Just as the insured has a duty to disclose, similarly, it is the duty of the insurers and their agents to disclose all material facts within their knowledge, since obligation of good faith applies to them equally with the assured. The duty of good faith is of a continuing nature. After the completion of the contract, no material alteration can be made in its terms except by mutual consent. The materiality of a fact is judged by the circumstances existing at the time when the contract is concluded.

                        12.1 The Supreme Court in Life Insurance Corporation of India V Asha Goel, (2001) 2 SCC 160 observed that the contracts of insurance including the contract of life assurance are contracts uberrima fides and every material fact must be disclosed, otherwise, there is good ground for rescission of the contract. It was also observed that for determination of the question whether there has been suppression of any material facts it may be necessary to also examine whether the suppression relates to a fact which is in the exclusive knowledge of the person intending to take the policy and it could not be ascertained by reasonable enquiry by a prudent person. It was observed as under:-

                        12. Coming to the question of scope of repudiation of claim of the insured or nominee by the Corporation, the provisions of section 45 of the Insurance Act is of relevance in the matter. The section provides, inter alia, that no policy of life insurance effected after the coming into force of this Act shall, after the expiry of two years from the date on which it was effected, be called in question by an insurer on the ground that a statement made in the proposal for insurance or in any report of a medical officer, or referee, or friend of the insured, or in any other document leading to the issue of the policy, was inaccurate or false, unless the insurer shows that such statement was on a material matter or suppressed facts which it was material to disclose and that it was fraudulently made by the policy-holder and that the policyholder knew at the time of making it that the statement was false or that is suppressed facts which it was material to disclose. The proviso which deals with proof of age of the insured is not relevant for the purpose of the present proceeding. On a fair reading of the section it is clear that it is restrictive in nature. It lays down three conditions for applicability of the second part of the section namely: - (a) the statement must be on a material matter or must suppress facts which it was material to disclose; (b) the suppression must be fraudulently made by the policy holder; and (c) the policy holder must have known at the time of making the statement that it was false or that it suppressed facts which it was material to disclose. Mere inaccuracy of falsity in respect of some recitals or items in the proposal is not sufficient. The burden of proof is on the insurer to establish these circumstances and unless the insurer is able to do so there is no question of the policy being avoided on ground of misstatement of facts. The contracts of insurance including the contract of life assurance are contracts uberrima fides and every fact of material must be disclosed, otherwise, there is good ground for rescission of the contract. The duty to disclose material facts continues right up to the conclusion of the contract and also implies any material alteration in the character of the risk which may take place between the proposal and its acceptance. If there are any misstatements or suppression of material facts, the policy can be called in question. For determination of the question whether there has been suppression of any material facts it may be necessary to also examine whether the suppression relates to a fact which is in the exclusive knowledge of the person intending to take the policy and it could not be ascertained by reasonable enquiry by a prudent person.

                        16. In course of time the Corporation has grown in size and at present it is one of the largest public sector financial undertakings. The public in general and crores of policy-holders in particular look forward to prompt and efficient service from the Corporation. Therefore the authorities in charge of management of the affairs of the Corporation should bear in mind that its credibility and reputation depend on its prompt and efficient service. Therefore, the approach of the Corporation in the matter of repudiation of a policy admittedly issued by it should be one of extreme care and caution. It should not be dealt with in a mechanical and routine manner.

                        12.2 The Supreme Court in Satwant Kaur Sandhu V New India Assurance Company Limited, (2009) 8 SCC 316 also observed that insurance is a contract falling in the category of contract uberrima fides meaning a contract of utmost good faith on the part of the assured. The assured is under a solemn obligation to make a true and full disclosure of the information which is within his knowledge when information on a specific aspect is asked for in the proposal form. However it is not for the proposer to determine whether the information is material for the purpose of the policy or not but obligation to disclose extends only to facts which are known to the applicant and not to what he ought to have known.

                        12.3 The Supreme Court in Reliance Life Insurance Company Limited & another V Rekhaben Nareshbhai Rathod in regard to 'materiality' held as under:-

                        28. Materiality of a fact also depends on the surrounding circumstances and the nature of information sought by the insurer. It covers a failure to disclose vital information which the insurer requires in order to determine firstly, whether or not to assume the risk of insurance, and secondly, if it does accept the risk, upon what terms it should do so. The insurer is better equipped to determine the limits of risk-taking as it deals with the exercise of assessments on a day-to-day basis. In a contract of insurance, any fact which would influence the mind of a prudent insurer in deciding whether to accept or not accept the risk is a material fact. If the proposer has knowledge of such fact, she or he is obliged to disclose it particularly while answering questions in the proposal form. An inaccurate answer will entitle the insurer to repudiate because there is a presumption that information sought in the proposal form is material for the purpose of entering into a contract of insurance.

                        29. Contracts of insurance are governed by the principle of utmost good faith. The duty of mutual fair dealing requires all parties to a contract to be fair and open with each other to create and maintain trust between them. In a contract of insurance, the insured can be expected to have information of which she/he has knowledge. This justifies a duty of good faith, leading to a positive duty of disclosure....

                        30. It is standard practice for the insurer to set out in the application a series of specific questions regarding the applicant's health history and other matters relevant to insurability. The object of the proposal form is to gather information about a potential client, allowing the insurer to get all information which is material to the insurer to know in order to assess the risk and fix the premium for each potential client. Proposal forms are a significant part of the disclosure procedure and warrant accuracy of statements. Utmost care must be exercised in filling the proposal form. In a proposal form the applicant declares that she/he warrants truth. The contractual duty so imposed is such that any suppression, untruth or inaccuracy in the statement in the proposal form will be considered as a breach of the duty of good faith and will render the policy voidable by the insurer. The system of adequate disclosure helps buyers and sellers of insurance policies to meet at a common point and narrow down the gap of information asymmetries. This allows the parties to serve their interests better and understand the true extent of the contractual agreement.

13. The main contention of the respondent no 1 and also argued by the counsel for the respondent no 1 that the investigation conducted by the respondent no 1 after submission of insurance claim by the appellant no 1 revealed that the insured was admitted in NHMMI Narayana Multispecialty Hospital on 25.03.2019 and had undergone percutaneous transluminal coronary angioplasty (PTCA) to left anterior descending artery and was also a known case of hypertension. It was emphatically argued that the insured has procured the subject policy on concealment of material facts and the counsel for the respondent no 1 also referred the medical record during arguments. The perusal of medical record reflected that the insured on 25.03.2019 was brought to NHMMI Narayana Multispecialty Hospital with history of chest pain, breathing problem and sweating. The insured was admitted for primary PTCA. The insured was found to be known case of hypertension. The medical record also reflected that the insured has undergone percutaneous transluminal coronary angioplasty (PTCA). The insured was discharged from hospital on 03.04.2019. It is established that the insured was admitted in hospital on 25.03.2019 and was diagnosed with severe LV dysfunction, primary PTCA, hypertension and various other ailments. There is force in the contention of the respondent no1 that the insured was known case of hypertension and was suffering from various ailments including PTCA.

14. We have also perused Member Consent Form for ICICI Pru Super Protect Credit. The perusal of Member Consent Form reflects that the insured did not disclose his previous ailments as detailed hereinabove in the Member Consent Form. The respondent no 1 due to concealment of previous ailments repudiated insurance claim of the appellant no 1 vide repudiation letter dated 30.06.2023. We have perused the repudiation letter dated 30.06.2023 addressed to the appellant no 1. The perusal of repudiation letter dated 30.06.2023 reflects that the respondent no 1 decided to repudiate all liabilities under the policies on account of the policy holder having withheld material information regarding his pre-existing disease. The relevant portion of the repudiation letter dated 30.06.2023 reads as under:-

                        Sub: Death claim under 'ICICI Pru Super Protect Credit policy number D6690809 on the life of Mr. Jagdish Ram Patel.

                        We refer to the death claim intimation submitted to the Company on April 24,2023 towards the above mentioned policy.

                        In this connection, we wish to state that the Company had received the proposal for insurance on October 7, 2022 through its sell online platform along with a duly signed Customer Declaration Form (CDF). The prospect also signs a physical CDF confirming the truthfulness and correctness of the details provided in the online proposal form and that any mis-statement or suppression or non-disclosure of material information will lead to repudiation of the claim. Relying on the replies/declarations provided in the proposal for insurance, the proposal was accepted and policy bearing number D6690809 was issued on October 14, 2022.

                        Please note that insurance business operates on the principle of utmost good faith and the Company relies on the details provided by the Life Assured to evaluate the risk.

                        As per the documents received by the Company at the time of death claim registration, it is noted that the Life Assured expired on February 17, 2023.

                        On assessment at claims stage it is noted that the Life Assured was admitted on March 25, 2019 and had undergone percutaneous transluminal coronary angioplasty (PTCA) to left anterior descending artery. Member was known case of hypertension. Further, we would like state that life assured was under treatment. The above stated medical history is prior to policy issuance.

                        We would like to state that the proposal for insurance requires the Life Assured to disclose correct facts, however it is observed that in the duly signed proposal for insurance received by the Company relevant questions were answered as follows:

Personal Details Of Member

1.

Have You ever suffered from/ been diagnosed with/ been treated any of the following? Heart Disease

No

2.

During the last 5 years, have you been advised to undergo any investigations or undergone any major surgery or been hospitalized or received any treatment for any medical condition except for minor cough, cold or flu for a continuous period of more than 14 days.

No

 
Had the correct medical history been disclosed in the proposal for insurance, the Company would have declined the proposal upfront and the policy would not have been issued.

In light of the above facts, we are constrained to decline your claim for the aforesaid policy. However, we are processing payment of premiums paid amounting to Rs. 54757/- (Rupees Fifty Four Thousand Seven Hundred Fifty Seven Only) under the said policy towards full and final settlement and the same shall be credited in Cholamandalam Securities Limited. The same is in lines with the amendments under Section 45 of the Insurance Act, 1938.

15. We have also considered the rival arguments advanced on behalf of the appellants and the respondents. The counsels for the appellants primarily argued that the insured had expired on 17.02.2023 during the subsistence of the policy period due to brain haemorrhage and thereafter the appellant no 1 lodged insurance claim before respondent no. 1 but the respondent no 1 vide letter dated 30.06.2023 repudiated the insurance claim of appellant no. 1 without any justification. The counsels for the appellants also attacked the impugned order passed by the State Commission by arguing that that the State Commission has erred while observing that the insured has supressed the material facts and the insured did not conceal the material information from the respondent no 1 at time of procuring policy. We are not in agreement with the arguments advanced on behalf of the appellants as it is established on record that the insured was suffering from various ailments prior to issuance of subject policy and did not disclose about his previous ailments in Member Consent Form which was tantamount to concealment of material facts.

                        15.1 As mentioned hereinabove the doctrine of uberrima fides is the basic principle of insurance and there must be complete good faith on the part of the insured. It is accepted legal proposition that a contract of insurance is contract uberrima fides and there must be complete good faith on the part of the assured as observed and held by the Supreme Court in Life Insurance Corporation of India V GM Channabasamma and various other pronouncements. The insured was under a solemn obligation to make full disclosure of material facts i.e. about his pre-existing decease in Member Consent Form which would have been relevant for the respondent no 1 to decide whether the proposal should be accepted or not. The Supreme Court in Life Insurance Corporation of India V Asha Goel, also reiterated that the contracts of insurance including the contract of life assurance are contracts uberrima fides and every material fact must be disclosed, otherwise, there is good ground for rescission of the contract.

                        15.2 The counsels for the appellants referred decisions delivered by this Commission in HDFC Standard Life Insurance Company Limited V Virpal NagarReliance Life Insurance Company Limited & another V Tarun Kumar Sudhir Halder and Neelam Chopra V Life Insurance Corporation of India. This Commission in HDFC Standard Life Insurance Company Limited V Virpal Nagar observed that it is settled proposition of law that the burden to prove undeclared pre-existing disease is upon the appellants and they are required to discharge this burden by producing any cogent evidence on record but the appellants has failed to point out any piece of evidence which could prove that the deceased was suffering from any pre-existing disease. It was also held that pre-existing disease means the disease for which the insured had been hospitalized or undergone in near proximity to the policy. The proposition of law as discussed in said cited decision does not provide any help to the arguments advanced on behalf of the appellants. The respondent no 1 remained admitted in the hospital as detailed hereinabove and also undergone PCTA. This Commission in Reliance Life Insurance Company Limited & another V Tarun Kumar Sudhir Halder observed that the onus to prove the pre-existing disease lies on the insurance company and the claim of the insured cannot be rejected due to life style disease like diabetes. The insured in the present case was not only suffering from life style disease such as hypertension but was also suffering from various other serious ailments as detailed herein above. The respondent no 1 has discharged the burden to prove that the insured was suffering from pre-existing serious ailments by placing medical records pertaining to the insured. We are not convinced with the arguments advanced by the counsels for the appellants and decision cited by the counsels for the appellants do not provide any assistance to the arguments advanced on behalf of the appellants.

16. We are in agreement and convinced by the arguments advanced on behalf of the respondent no 1 that the respondent no 1 based on declaration in Master Consent Form issued the subject Member Policy bearing no D6690809 for sum assured of Rs. 30,00,000/- on 14.10.2022. The respondent no 1 after submission of death claim found that the insured had previously undergone Percutaneous Trans-Luminal Coronary Angiography (PTCA) from NHMMI Narayana Multispecialty Hospital, Raipur and was a known case of Hypertension. The counsel for the respondent no 1 rightly argued that the insured did not disclose his medical history in Member Consent Form and as concealed material information. We are in complete agreement with the contentions of the respondent no 1 that the respondent no 1 correctly voided the policy vide letter dated 30.06.2023.

17. We have perused the order dated 03.05.2024 passed by the District Forum and the impugned order passed by the State Commission. The District Forum vide order dated 03.05.2024 wrongly held that the respondent no 1 was guilty of deficiency in service. The State Commission vide impugned order rightly observed that insured before taking the policy was admitted in NHMMI Narayana Hospital between 25.03.2019 to 03.04.2019 and was suffering from heart disease and hypertension. The State Commission after proper appreciation of facts rightly held that that the insurance claim was cancelled due to concealment of material facts regarding his illness in violation of terms of policy and there was no deficiency in service by the respondent no 1.

18. We after careful analysis of material placed on record and rival contentions and arguments of the appellants and the respondents do not find any infirmity in the impugned order passed by the State Commission which was passed after appropriate appreciation of facts and law. The present appeals do not involve any substantial question of law. There is no reason to interfere in the impugned order passed by the State Commission. Accordingly, the present Second Appeals being devoid of merit are dismissed and the pending applications, if any also disposed of.

 
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