Avm Jonnalagadda Rajendra, Avsm, Vsm (Retd), Member

1. This Revision Petition has been filed under Section 21(b) of the Consumer Protection Act, 1986 (the "Act") against the order of Bihar State Consumer Disputes Redressal Commission at Patna (“State Commission‟) dated 02.11.2017 in FA No. 19/2015 dismissing the Appeal filed by the Petitioner/OP and affirmed the District Consumer Disputes Redressal Forum, Rohtas-Sasaram, (“the District Forum‟) order dated 06.01.2015 which partly allowed the complaint.

2. For convenience, the parties are referred to as placed in the original Complaint filed before the District Forum.

3. Brief facts of the case, as per the complainant, are that his wife, Kamala Devi, had obtained three insurance policies from L.I.C., Dehri- on-Sone Branch, namely a Money Back Policy, Jeevan Sathi, and Jeevan Anand, bearing Policy Nos. 513897911 for Rs. 51,000/-; 513534219 for Rs. 1,00,000/-; and 513520931 for Rs. 1,00,000/-, which commenced on 28.01.2004, 15.06.2004, and 23.09.2004 respectively. The policies covered the life of his wife, who unfortunately died on 25.09.2004 at about 4:00 A.M. after suddenly falling ill the previous night. The complainant informed the L.I.C. office, submitted the death certificate, claim form, affidavit as nominee, and other required documents, and repeatedly approached the office for settlement of the claim. As no payment was made, he served a legal notice dated 12.01.2009, which was replied to on 08.12.2009 without any settlement, compelling him to file a case before the District Forum claiming the insured amount of Rs. 2,51,000 along with damages and compensation.

4. The OPs, in their Written Version, contested the claim, asserting that the complaint is not maintainable, time-barred, and devoid of cause of action. The OPs contended that the complainant suppressed material facts regarding the prior illness of the insured, who died within two days of obtaining the last policy, thereby raising serious suspicion. It was further contended that the policies had lapsed due to non-payment of premiums and that the complainant failed to submit necessary documents despite repeated requests. The OPs also pointed out discrepancies regarding the insured‟s age, occupation, and personal details, necessitating further investigation through Form B or B-1, which the complainant allegedly failed to provide. On these grounds, the opposite parties prayed for dismissal of the complaint.

5. The learned District Forum vide Order dated 06.01.2015 partly allowed the complaint with the following directions:-

                          "14. Hence the claim of the complainant is accepted and O.P. No.2 to 5 is hereby directed to pay Rs.2,51,000/- amount as policy amount Rs.20,000/- against the mental tension and economic loss and Rs.5000/- Thousand as cost of litigation total 2,76,000/- within two months since the date of order. In case of not payment within the stipulated period, the complainant shall entitled to get 9% interest thereon."

                          (Extract from translated copy)

6. Being aggrieved by the District Forum order, the OPs filed Appeal No.19 of 2015 and the State Commission vide order dated 02.11.2017 dismissed the Appeal with following observations:

                          "4. Heard the counsel for the appellants LIC as well as the counsel appearing for the respondent. We have perused the entire materials available on record along with impugned order in detail.

                          5. Admittedly, the deceased assured Kamala Devi had three policies for total sum of Rs. 2,51,000/- and the complainant as nominee and the deceased died during valid period of the polices is not dispute. Now so far as the objections raised by the LIC with respect to concealment of correct information while taking the polices in question is concerned we are of the opinion that the District Forum has gone in to every aspect of the issue in detail and after consideration of entire materials on the basis of evidences arrived at conclusion in favor of the complainant which appears quite reasonable and just. We therefore do not find any reason to interfere with the order passed by the District Forum and as such the same stands confirmed.

                          6. In result, the appeal stands dismissed."

7. Being dissatisfied by the Impugned Order dated 02.11.2017 passed by the State Commission, the Petitioner/OP has filed the instant Revision Petition bearing no.793 of 2018.

8. The learned counsel for the Petitioner/OP argued that upon receipt of three duly filled and signed proposal forms on different dates and relying upon the declarations made therein as true and correct, the OP issued 3 life insurance policies Nos. 513420931 (commenced on 28.01.2004 for sum assured of Rs.51,000 under Money Back Plan);

Policy No.513534219 (commenced on 15.06.2004 for a sum assured of Rs.1,00,000 under Jeevan Saathi Joint Life Plan); and No. 513897911 (commenced on 23.09.2004 for sum assured Rs.1,00,000 under Jeevan Anand) in the name of late Kamla Devi, who was reported to have died on 25.09.2004, merely two days after commencement of the third policy. Thereafter, OP/petitioner received death claim intimation in September 2006. Vide letters dated 22.09.2006 and 03.10.2011, OP repeatedly called upon the complainant to submit mandatory claim documents, which were never furnished despite due opportunity, compelling them to conduct an investigation in view of the early death claim, wherein the claim was found to be not genuine and revealed material concealment and misrepresentations by the Life Assured regarding her age, occupation, income and existing policies, including inconsistent dates of birth, non-disclosure of prior policies, false projection of agricultural and tailoring income to qualify for higher insurance cover, and suppression of pre-existing heart ailment treated at Varanasi prior to issuance of all three policies. These rendered her ineligible under the applicable underwriting guidelines for the 2nd and 3rd policies of Rs.1,00,000 each, notwithstanding the pendency of the claim due to non-submission of documents. As against filing requisite records, the complainant filed Consumer Complaint No. 47/2010 with inordinate delay of over five years from the date of death, which was clearly barred by limitation. The District Forum, however, vide order dated 06.01.2015 erroneously allowed the complaint and directed payment of Rs.2,76,000 towards the policies. The Appeal filed by the OP was dismissed by the State Commission vide a non-speaking order dated 02.11.2017, without considering their specific pleadings and submissions, contrary to the settled law laid down by the Hon‟ble Supreme Court in H.V.P.N.L. v. Mahavir, AIR 2000 SC 3586, thereby warranting interference by this Commission and setting aside of the order in the interest of justice.

9. Per contra, the learned counsel for complainant argued that he had taken, in the name of his wife Late Kamla Devi, three life insurance policies from the respondent-LIC, namely (i) Money Back Policy No. 51389711 for a sum assured of Rs.51,000/-, (ii) Jeevan Sathi (Joint Life) Policy No. 513534219 for Rs.1,00,000/-, and (iii) Jeevan Anand Policy No. 513520931 for Rs.1,00,000/-, valid from 28.01.2004, 15.06.2004 and 23.09.2004 respectively, the Jeevan Sathi Policy being in the joint names of Kamla Devi and the complainant. Unfortunately, Kamla Devi suddenly fell ill on the night of 25.09.2004 and expired during transit for medical treatment. Whereafter, the complainant, being the nominee, duly submitted the claim along with all requisite records within time, including death certificate, affidavits and other proofs, and also cooperated with the investigation conducted by the LIC officials, including recording of witness statements, yet the claim was not settled despite repeated visits and issuance of a legal notice dated 12.11.2009, compelling him to approach the District Forum. The Forum, by a well- reasoned order dated 06.01.2015, categorically held that the deceased was insured during the valid subsistence of the policies, there was no evidence of any pre-existing illness or concealment of material facts, the proposal forms were admittedly filled by the authorised LIC agent as the deceased was illiterate and the repudiation on technical grounds was unjustified. The District forum accordingly directed for payment of Rs.2,76,000/- with interest. The said order was affirmed in Appeal by the State Commission, Bihar, Patna in Appeal No. 19 of 2015, holding that the objections raised by LIC were unsupported by evidence and these details ought to have been verified at the time of issuance of policies itself. Therefore, there are concurrent findings which are just, proper and based on principles of natural justice. He asserted that the present revision petition is liable to be dismissed with exemplary costs.

10. We have examined the pleadings and associated documents placed on record and rendered thoughtful consideration to the arguments advanced by the learned counsels for both the parties.

11. The principal issues for consideration are whether the life assured was under a duty to disclose his alleged history of heart disease; whether there was any suppression of material facts; and whether such suppression, if any justified claim repudiation?

12. It is undisputed that the DLA, in the proposal forms answered "No" to Questions 11(i) to 11(vii i& x) and described her usual state of health as "Good" in Question 11(ix). The Complainant contended that at the time of obtaining the policy, the insured was not suffering any known disease and did not take any prior treatment warranting disclosure.

13. The law governing insurance contracts is well settled. Insurance is a contract of utmost good faith. However, the burden to establish suppression of material facts lies squarely on the insurer. The Hon‟ble Supreme Court in United India Insurance Co. Ltd. Vs M/s Hyundai Engineering & Construction Co Ltd & Ors, 2024 LiveLaw 409 has held:

                          "16. Insurance is a contract of indemnification, being a contract for a specific purpose, Oriental Insurance Co. Ltd. v. Sony Cheriyan, (1999) 6 SCC 451, which is to cover defined losses, United India Insurance Co. Ltd. v. Levis Strauss (India) (P) Ltd., (2022) 6 SCC 1. The courts have to read the insurance contract strictly. Essentially, the insurer cannot be asked to cover a loss that is not mentioned. Exclusion clauses in insurance contracts are interpreted strictly and against the insurer as they have the effect of completely exempting the insurer of its liabilities, New India Assurance Co. Ltd. v. Rajeshwar Sharma, (2019) 2 SCC 671; Canara Bank v. United India Insurance Co. Ltd., (2020) 3 SCC 455; Oriental Insurance Co. Ltd. v. Samayanallur Primary Agricultural Coop. Bank, (1999) 8 SCC 543.

                          17. In Texco Marketing P. Ltd. v. TATA AIG General Insurance Company Ltd., Oriental Insurance Co. Ltd. v. Samayanallur Primary Agricultural Coop. Bank, (2023) 1 SCC 428, while dealing with an exclusion clause, this Court has held that the burden of proving the applicability of an exclusionary clause lies on the insurer. At the same time, it was stated that such a clause cannot be interpreted so that it conflicts with the main intention of the insurance. It is, therefore, the duty of the insurer to plead and lead cogent evidence to establish the application of such a clause, National Insurance Company Ltd. v. Vedic Resorts and Hotels Pvt. Ltd., 2023 SCC OnLine SC 648. The evidence must unequivocally establish that the event sought to be excluded is specifically covered by the exclusionary clause, National Insurance Co. Ltd. v. Ishar Das Madan Lal, 2007 (4) SCC 105. The judicial positions on the nature of an insurance contract, and how an exclusion clause is to be proved, shall anchor our reasoning in the following paragraphs."

14. In Narsingh Ispat Ltd Vs Oriental Insurance Company Ltd. & Anr 2022 LiveLaw (SC) 443, Hon‟ble Supreme Court reiterated National Insurance Co Ltd vs Ishar Das Madan Lal (2007) 4 SCC 105 (Para 12) and held that exclusionary clauses and allegations of suppression must be strictly proved by cogent and reliable evidence, and in case of ambiguity, the benefit must go to the insured.

15. In the present case, both the District Forum and the State Commission, upon a detailed appraisal of the evidence on record, have concurrently held that the OP insurer failed to establish that the insured had knowledge of any pre-existing disease or that there was any deliberate and material suppression of facts at the time of submission of the proposal form. The Report dated 15.01.2009 was merely internal to OP and prepared by the Manager Legal & HPF. No contemporaneous medical records were produced or relied upon by OPs to substantiate the contentions. The documents placed on record, merely indicated illness at a subsequent stage, were rightly found by the fora below to be insufficient to prove conscious or intentional suppression of material facts as on the date of the proposal. These are pure findings of fact, based on due appreciation of the evidence on record.

16. In addition to the above, while the Deceased Life Assured died on 25.09.2004 and the claim was made immediately thereafter, the OP had sought additional information from the Complainant much later on 27.09.2006 and 03.01.2011. Further, in the Report dated 15.01.2009 prepared by the Manager Legal & HPF it was recorded that "During the enquiry I felt the case is not genuine. But could not gather any evidence." Bringing the case of the Complainant within the exclusion clause under the policy, without adequate corroboration and repudiation of the claim by the OP is untenable.

17. The scope of revisional jurisdiction under Section 21(b) of the Consumer Protection Act, 1986 is extremely limited. As held by the Hon‟ble Supreme Court in Rubi (Chandra) Dutta v. United India Insurance Co. Ltd., (2011) 11 SCC 269, Sunil Kumar Maity v. SBI (Civil Appeal No. 432 of 2022), and Rajiv Shukla v. Gold Rush Sales and Services Ltd., (2022) 9 SCC 31, this Commission cannot interfere with concurrent findings of fact unless the same are shown to be perverse or suffering from jurisdictional error or material irregularity.

18. In view of the foregoing discussion, we hold that the OP failed to establish any material suppression or misrepresentation on the part of the Deceased Life Assured so as to justify repudiation of the death claim under the policy. The concurrent findings recorded by the District Forum in C.C. No. 47/2010 dated 06.01.2015 and affirmed by the State Commission in FA. No.19/2015 dated 02.11.2017 are based on proper appreciation of evidence and do not suffer from any illegality, material irregularity or jurisdictional error. The Revision Petition No.793 of 2018 is accordingly dismissed.

19. In the facts and circumstances of the case, there shall be no order as to costs.

20. All pending applications, if any, stand disposed of accordingly.