State Consumer Disputes Redressal Commission
Icici Prudential Insurance Company ... vs Smt. Sitara Begum on 25 May, 2026
SC/5/A/25/2023 ICICI Prudential Life Ins. Co. Ltd. 22.05.2026
& Anr.
Vs.
Sitara Begum
STATE CONSUMER DISPUTES REDRESSAL COMMISSION UTTARAKHAND,
DEHRADUN
Date of Admission : 23.08.2025
Date of Final Hearing : 04.05.2026
Date of Pronouncement : 22.05.2026
SC/5/A/25/2023
1. ICICI Prudential Life Insurance Company Limited
Managing Director, Bhutal Unit No. 1, A.S. 2 A,
Raheja Tipco Plaza, Rani Sati Marg, Malad (East)
Mumbai - 400097
2. Branch Manager,
ICICI Prudential Life Insurance Company Limited
Opposite Tourist Restaurant, Near Indian Bank
Ramnagar Road, Kashipur, Uddhamsingh Nagar, Uttarakhand
(Through: Sh. Madan Pal Singh, Advocate)
.....Appellants
VERSUS
Smt. Sitara Begum W/o Late Sh. Shakeel Ahmed
Near Siddique Marriage Hall, Kashipur,
District Uddhamsingh Nagar, Uttarakhand
(Through: Sh. Nadim Uddin & Sh. Pradeep Bartwal, Advocates)
.....Respondent
Coram:
Ms. Kumkum Rani, President
Mr. C.M. Singh, Member
ORDER
(Per: Mr. C.M. Singh, Member):
This appeal has been directed against judgment and order dated 28.09.2022 passed by the learned District Consumer Disputes Redressal 1 SC/5/A/25/2023 ICICI Prudential Life Ins. Co. Ltd. 22.05.2026 & Anr.
Vs. Sitara Begum Commission, Uddhamsingh Nagar in consumer complaint No. 30 of 2020 styled as Smt. Sitara Begum vs. ICICI Prudential Life Insurance Company Limited & Anr., wherein and whereby the complaint was allowed directing the opposite parties, jointly or severally, to pay Rs. 50,00,000/- to the complainant within 30 days from the date of judgment and order alongwith interest @ 6% per annum from the date of filing of consumer complaint, i.e. 01.09.2020 till its actual payment to the complainant. The opposite parties shall also pay Rs. 5,000/- towards litigation expenses to the complainant.
2. For the sake of convenience, the parties shall be referred to in the same manner as in the consumer complaint.
3. Brief facts of the present appeal are as such that the husband of the complainant Late Shakeel Ahmed obtained a life insurance policy bearing No. 48109966 from the opposite parties after paying premium of Rs. 7,357/-. The said policy carried a sum assured of Rs. 50 Lacs and the complainant was nominee therein. It is alleged that the insured died on dated 29.10.2019, thereafter the complainant submitted insurance claim with the opposite parties for payment of insured amount. However, the claim was repudiated by the opposite parties on the allegations that the insured had concealed the material facts regarding his previous illness namely Coronary Artery Disease (in short 'CAD'), while filing the proposal form. The complainant denied the allegation of concealment and asserted that the insured was not suffering from any such disease and had not suppressed any material information relating to his health condition. According to the complaint, the insurance company illegally repudiated the claim on false and baseless grounds, despite the fact that the policy in question, which had been issued only after medical examination of the insured and satisfaction regarding this health condition. Alleging 2 SC/5/A/25/2023 ICICI Prudential Life Ins. Co. Ltd. 22.05.2026 & Anr.
Vs. Sitara Begum deficiency in service and unfair trade practice on the part of the opposite parties in repudiating the claim, the complainant filed a consumer complaint seeking payment of insured amount alongwith compensation and litigation expenses.
4. The opposite parties filed their written statement denied the allegations in complaint case and contended that the contract of insurance is founded upon the principle of utmost good faith which requires the insured to disclose all the material facts truthfully in the proposal form. It was pleaded that as on date of insurance policy, i.e. 21.09.2019, the insured has concealed his previous medical history relating to CAD while obtaining the policy. According to the answering opposite parties, since the insured died within very short period from the date of issuance of insurance policy in question, i.e. after only one month & 7 days, a detailed investigation was conducted. During the course of investigation, it was allegedly found that the insured had been suffering from CAD since the year 2017 and had been undergoing treatment under Dr. Vishal Hussain. It was contended that had these material facts been disclosed at the time of submission of proposal form, the answering opposite parties could not have issued the policy. Relying upon Section 45 of Insurance Act, 1938, the insurance company pleaded that the claim was rightly repudiated on account of suppression of material facts by the insured. It was further stated that the insured himself was working as the insurance agent and was fully aware of the importance of disclosure of material fact in the insurance contract. Denying any deficiency in service or unfair trade practice on their part, the answering opposite parties prayed for dismissal of the complaint case.
5. The District Commission after hearing both the parties and after taking into consideration the facts and evidence on record, has passed the 3 SC/5/A/25/2023 ICICI Prudential Life Ins. Co. Ltd. 22.05.2026 & Anr.
Vs. Sitara Begum impugned judgment and order dated 28.09.2022 wherein and whereby the complaint was allowed in the above manner.
6. On having been aggrieved by the aforesaid judgment and order of the District Commission, the opposite parties have filed the present appeal as appellants. The opposite parties have stated that the impugned judgment and order passed by the District Commission is patently erroneous, perverse and contrary to the facts and evidence available on record and has been passed without appreciation of law and evidence, hence the impugned judgment and order is liable to be set aside. The District Commission has failed to appreciate that the present matter involved complicated questions of law and facts relating to material non-disclosure, suppression of material fact, tampering and fabrication of documents and allegations of fraud, which could not have been properly adjudicated in summary proceedings before the Consumer Commission. The District Commission further failed to properly appreciate the material evidence available on record and recorded the findings contrary to the documentary evidence and settled principles governing contract of insurance. The finding of the District Commission regarding absence of concealment of material fact, is wholly erroneous and against the record. In as much as the medical documents and investigation report clearly established that the insured had been suffering from CAD prior to obtaining the policy in question. The District Commission had also erred in discarding the medical records and certificate produced by the opposite parties without assigning cogent and legally sustainable reason. The District Commission has failed to appreciate that the contracts of insurance are governed by principle of utmost good faith (uberima fides) and the insured was under legal obligation to disclose all the material facts relating to his health condition in the proposal form. It further failed to consider that the insured had died within a very short period from the issuance of policy in question, thereby full justifying detailed 4 SC/5/A/25/2023 ICICI Prudential Life Ins. Co. Ltd. 22.05.2026 & Anr.
Vs. Sitara Begum investigation into the claim by the Insurance Company. The District Commission has also failed to correctly appreciate the provisions of Section 45 of Insurance Act, 1938 which subsequently entitled the Insurer to repudiate the policy on account of suppression and misrepresentation of material facts within the prescribed period. The District Commission further committed grave error in placing reliance upon the subsequent statement / certificate of Dr. Vishal Hussain while completely ignoring the documentary contemporaneous medical records and documents collected during the course of investigation.
7. Learned counsel Sh. Madan Pal Singh for the appellants - opposite parties and learned counsel Sh. Nadim Uddin & Sh. Pradeep Bartwal for respondent - complainant have appeared.
8. We have heard arguments of both the learned counsel and perused the material available on record.
9. It is admitted that the Late Shakeel Ahmad had obtained a life insurance policy bearing No. 48109966 from the opposite parties for a sum insured of Rs. 50 Lacs and the complainant was nominee under the said policy. It is also admitted that the policy in question commenced on dated 21.09.2019 and the insured died on dated 29.10.2019, thereafter the complainant lodged the insurance claim before the opposite parties. It is also not disputed that the claim was repudiated by the opposite parties vide letter dated 31.03.2020 on the ground of alleged concealment and suppression of material facts to the health condition of the insured and refunded the premium of Rs. 7,357/- to the complainant's bank account.
10. Learned counsel for the opposite parties has argued that the insured had obtained the life insurance policy in question with suppression of 5 SC/5/A/25/2023 ICICI Prudential Life Ins. Co. Ltd. 22.05.2026 & Anr.
Vs. Sitara Begum material facts regarding his health condition. He also argued that the insured died within the short period, i.e. after one month 7 days from the date of purchase of policy and hence an investigation was carried out in which it was found that the insured by suffering from previous illness, i.e. Coronary Artery Disease.
11. Learned counsel for complainant has argued that complainant's husband - insured was not suffering from any previous illness as also certified by the family doctor, namely Dr. Vishal Hussain.
12. The principle controversy involved in the present appeal relates to the alleged suppression of material facts by the insured - deceased at the time of obtaining the insurance policy. The opposite parties repudiated the insurance claim on the ground that the insured - deceased had been suffering from CAD, prior to obtaining the policy in question and deliberately suppressed the said facts while submitting the proposal form.
13. Upon careful perusal of the records, it is observed that a non-medical insurance policy was obtained by the insured on the basis of good health declaration certificate. It is further observed that a family doctor's certificate dated 23.12.2019 (paper No. 118 of the appeal record) was submitted by the complainant alongwith claim form in which the family doctor mentioned by the complainant is Dr. Vishal Hussain. On the basis of this certificate, the opposite parties obtained a certificate dated 14.03.2020 (paper Nos. 21/1 to 21/3 of the District Commission's record) issued by the said doctor, Dr. Vishal Hussain of Jansewa Hospital, Kashipur, Uddhamsingh Nagar, wherein it was stated that the deceased - insured had been under his treatment for the preceding two years and was known case of CAD diagnosed on dated 16.05.2017. In the aforesaid certificate, the name of deceased was mentioned as "Shakil Ahmad"
6SC/5/A/25/2023 ICICI Prudential Life Ins. Co. Ltd. 22.05.2026 & Anr.
Vs. Sitara Begum whereas in the insurance policy, the name of insured is recorded as "Shakeel Ahmad". On the other hand, the complainant filed a certificate (paper No. 18 of the District Commission's record) dated 13.11.2020 issued by the same doctor namely Dr. Vishal Hussain of Jansewa Hospital, Kashipur, Uddhamsingh Nagar wherein it was certified that late Shakeel Ahmad S/o Rafiq Ahmad R/o Alli Khan Kashipur was well-known to the doctor and had never undergone the treatment for any major illness. It was certified that the deceased was not suffering from any major medical or surgical ailment including CAD. In the said certificate, the spelling of the name was mentioned as 'Shakeel Ahmad' identical to the spelling recorded in the insurance policy. In view of contradictory certificates, Dr. Vishal Hussain was summoned for examination before the District Commission (paper No. 26 of the District Commission's record). During his examination, the witness stated that the certificate dated 14.03.2020 issued at paper Nos. 21/1 to 21/3 and certificate dated 13.11.2020 issued at paper No. 18 pertain to two different individuals and were not related to the same person. It is further significant to note that the concerned Doctor did not obtain or produce any identity proof, address proof or other supporting documents to establish that the certificates dated 14.03.2020 and 13.11.2020 pertains to two different individuals. In the absence of any documentary evidence establishing distinct identity of the alleged two persons, the statements of the witness, namely Dr. Vishal Hussain that the said certificates related to different individuals does not inspire confidence and cannot be accepted.
14. However, upon careful scrutiny of the entire record, it appears that the learned District Commission placed the sole reliance upon the statement of doctor while ignoring the surrounding circumstances and documentary evidence available on record. A perusal of Annexure attached with the certificate dated 14.03.2020 (paper Nos. 21/2 to 21/3 of the District 7 SC/5/A/25/2023 ICICI Prudential Life Ins. Co. Ltd. 22.05.2026 & Anr.
Vs. Sitara Begum Commission's record in which the said doctor has certified that the insured was suffering from CAD) reveals that the date of birth of life assured Shakil Ahmad has recorded as 02.06.1977 and date of death is mentioned as 29.10.2019. Similarly, in claim form (paper No. 12/19 of the District Commission's record) date of birth of Shakeel Ahmad is recorded as 02.06.1977 and date of death is recorded as 29.10.2019. This aforesaid fact clearly establish that Shakil Ahmad and Shakeel Ahmad refereed to one and same person and that the variation in spelling is merely clerical in nature. The possibility of two different persons having the same date of birth, date of death, obtaining insurance policy from the same insurance company and having the same family doctor is highly improbable and cannot ordinarily be accepted. Further, a perusal of record reveals that Dr. Vishal Hussain himself in Family Doctor Certificate (paper No. 118 of the appeal record) mentioned the name of the insured as Shakil Ahmad. The said Family Doctor Certificate was submitted by the complainant alongwith claim form and subsequently mentioned the number of policy in question. These circumstances clearly indicates that the names of Shakil Ahmad and Shakeel Ahmad were being used interchangeably in the documents pertaining to the same insured person thereby referring the subsequent statement of the Dr. Vishal Hussain that the certificates pertain to the different individuals unreliable and contrary to the facts available on record. Moreover, the address mentioned in the aforesaid family doctor (paper No. 118) certificates is similar to the address mentioned in the death certificate of the insured (paper No. 60 of the appeal record), which further corroborates that both the documents pertain to the same individual.
15. The District Commission has also failed to appreciate that the insured died within a very short period from issuance of the policy, i.e. one month and 7 days, thereby justify a detailed investigation by the Insurance Company. The contract of insurance is covered by the principle of 8 SC/5/A/25/2023 ICICI Prudential Life Ins. Co. Ltd. 22.05.2026 & Anr.
Vs. Sitara Begum uberrima fides requiring the insured to disclose all the medical facts relating to his health condition. The material placed on record by the opposite parties particularly the certificates and investigation reports indicate that the insured had been suffering from CAD prior to obtaining the insurance policy in question. The District Commission had further failed to properly appreciate the provision of Section 45 of Insurance Act, 1938 which entitled the insurer to repudiate the claim on account of suppression and misrepresentation of material facts within the prescribed period.
16. Learned counsel for complainant has cited following case laws, which are as under:-
1. Sarbani Chatterjee vs. Life Insurance Corporation of India & 4 Ors., 2024 STPL 4186 NCDRC [III (2023) CPJ 332] decided on 18.05.2023.
2. Life Insurance Corporation of India vs. Smt. G.M. Channabasemma, 1990 STPL 6871 SC [AIR 1991 SC 392] decided on 06.12.1990.
3. Life Insurance Corporation of India vs. Smt. Geeta Rani, 2022 STPL 9336 UK [II (2022) CPJ 130] decided on 09.03.2022.
4. Bharti AXA Life Insurance Co. Ltd. & Anr. vs. Madhu Mishra & 3 Ors., 2025 STPL 532 NCDRC [IV (2024) CPJ 1 (NC)] decided on 02.08.2024.
5. Sucha Singh vs. Head Branch Office, HDFC Life And Another, 2023 STPL 2775 9 SC/5/A/25/2023 ICICI Prudential Life Ins. Co. Ltd. 22.05.2026 & Anr.
Vs. Sitara Begum NCDRC [(2022) 4 CPJ 159] decided on 21.09.2022.
6. Pratibha Bevinal vs. Metlife India Insurance Co. Ltd., 2023 STPL 2795 NCDRC [(2022) 4 CPJ 289] decided on 07.10.2022.
17. In the case of Sarbani Chatterjee (supra), the Hon'ble Commission has held that the proposal form had been countersigned by the authorized Medical Officer of the insurance company and, therefore, the insurer was already aware of the medical condition of the proposer at the time of issuance of the policy. In the said circumstances, repudiation of the claim on the ground of suppression of illness was not found justified. However, the facts of the said case are clearly distinguishable from the facts of the present case, inasmuch as no such material has been placed on record in the instant matter to establish that the insurance company had prior knowledge of the alleged medical condition of the insured at the time of issuance of the policy. Hence, the ratio laid down in Sarbani Chatterjee (supra), is not applicable to the present case..
18. In the case of Life Insurance Corporation of India vs. Smt. G.M. Channabasemma (supra), the Hon'ble Apex Court has held that the deceased - insured had been medically examined by the doctor authorized by the insurance company, who had certified the good health of the insured at the time of obtaining the insurance policy. In those circumstances, the insurer was deemed to have been satisfied regarding the health condition of the insured. However, the facts of the present case are entirely different and distinguishable, as no such material has been brought on record to establish that the insurer had prior knowledge of the alleged disease of the insured at the time of issuance of the policy. Hence, the ratio laid down in the 10 SC/5/A/25/2023 ICICI Prudential Life Ins. Co. Ltd. 22.05.2026 & Anr.
Vs. Sitara Begum aforesaid judgment is not applicable to the facts and circumstances of the present case.
19. In the case of Life Insurance Corporation of India vs. Smt. Geeta Rani (supra), the alleged disease suffered by the life assured, as mentioned in the certificates issued by the medical practitioner, was illegible and there was no cogent evidence from the concerned doctor clarifying the treatment allegedly provided to the life assured or the nature of the disease for which such treatment was given. In the absence of clear and reliable medical evidence, the Hon'ble Commission declined to rely upon the said documents. However, the facts of the present case are clearly distinguishable, as the medical certificates and supporting documents on record specifically refer to coronary artery disease and are further corroborated by the surrounding circumstances and documentary evidence available on record. Hence, the ratio laid down in this case is not applicable to the facts of the present matter.
20. In the case of Bharti AXA Life Insurance Co. Ltd. & Anr. vs. Madhu Mishra (supra), the Hon'ble National Commission held that the unproved documents could not be relied upon as the same were neither original documents nor supported by the affidavit or evidence of the concerned doctor. However, the facts of the present case are clearly distinguishable, inasmuch as the documents relied upon by the opposite parties stand corroborated by other documentary evidence and surrounding circumstances available on record. Moreover, Dr. Vishal Hussain himself appeared before the learned District Commission and admitted issuance of the certificates in question. Therefore, the ratio laid down in the aforesaid case is also not applicable to the facts and circumstances of the present matter.
11SC/5/A/25/2023 ICICI Prudential Life Ins. Co. Ltd. 22.05.2026 & Anr.
Vs. Sitara Begum
21. In the case of Sucha Singh (supra), the issue involved related to the revival of the original insurance policy and the applicability of Section 45 of the Insurance Act, 1938 in the context of such revival. The facts and circumstances of the said case are entirely different from those of the present matter, which pertains to alleged suppression of material facts at the time of obtaining the policy itself. Therefore, the ratio laid down in the aforesaid judgment is also not applicable to the facts of the present case.
22. In the case of Pratibha Bevinal (supra), the death of the life assured had occurred due to a road accident and not on account of any disease. In the said case, the insurance policy had been issued after medical examination and tests conducted by the insurer, and subsequently the life assured died in an accident. However, the insurance company sought to repudiate the claim on the ground that the deceased was suffering from a pre-existing disease. The facts of the said case are clearly distinguishable from the present matter, as the controversy in the instant case directly relates to alleged suppression of material facts concerning coronary artery disease prior to obtaining the insurance policy. Hence, the ratio laid down in the aforesaid judgment is not applicable to the facts of the present case.
23. In view of the above, we are of the considered opinion that the District Commission has erred in appreciation of the material facts and law, while passing the impugned judgment and order. Therefore, we hold that the impugned judgment and order is liable to be set aside and the appeal deserves to be allowed.
24. Accordingly, the appeal is allowed. Impugned judgment and order dated 28.09.2022 passed by the District Commission, Uddhamsingh Nagar is hereby set aside. Consumer complaint shall stand dismissed. No order as to costs of the appeal.
12SC/5/A/25/2023 ICICI Prudential Life Ins. Co. Ltd. 22.05.2026 & Anr.
Vs. Sitara Begum
25. Statutory amount, if any, deposited by the appellants - opposite parties be returned to the appellants - opposite parties.
26. A copy of this Order be provided to all the parties free of cost as mandated by the Consumer Protection Act, 1986 /2019. The Order be uploaded forthwith on the website of the Commission for the perusal of the parties. The copy of this order alongwith original record of the District Commission, Uddhamsingh Nagar be sent to the concerned District Commission for record and necessary information.
27. File be consigned to record room along with a copy of this Order.
(Ms. Kumkum Rani) President (Mr. C.M. Singh) Member Pronounced on: 22.05.2026 13