National Consumer Disputes Redressal
Life Insurance Corporation Of India vs Shreekunwar S/O. Late Ram Lakhan ... on 16 October, 2025
IN THE NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION
NEW DELHI
RESERVED ON : 29.08.2025
PRONOUNCED ON : 16.10.2025
REVISION PETITION NO. 289 OF 2025
(From the order dated 20.11.2024 in Appeal No. 173/2019 of the State
Consumer Disputes Redressal Commission, Uttar Pradesh)
With IA No. 1560 of 2025
1. Life Insurance Corporation of India Petitioner(s)
Branch Office, Gandhi Market
Orai District Jalaun
2. Divisional Manager
North Central Zonal Office
LIC of India
Jeevan Vikas
16/275, Civil Lines, Mahatma Gandhi Marg
Post Box No. 170 Kanpur
Through Deputy Secretary
Life Insurance Corporation of India
Zonal Office ( Legal Cell)
Hazratganj, Lucknow
Versus
Shree Kunwar Respondent
w/o Late Ram Lakhan Prajapati
r/o Near Santoshi Mata temple
Rajendra Nagar, Oral District Jalaun, U.P.
BEFORE:
HON'BLE DR. INDER JIT SINGH, PRESIDING MEMBER
HON'BLEDR. JUSTICE SUDHIR KUMAR JAIN, MEMBER
For the Petitioner(s) Mr. Santosh Kumar, Advocate
For the Respondent(s) Mr. Sanjoit Ray, Advocate
RP/289/2025 Page 1 of 12
ORDER
1. The present Revision Petition (RP) has been filed by the Petitioner against the Respondent as detailed above, under section 58 (1) (b) of Consumer Protection Act 2019, against the order dated 20.11.2024 of the State Consumer Disputes Redressal Commission Uttar Pradesh (hereinafter referred to as the 'State Commission'), in First Appeal (FA) No 173 of 2019 in which order dated 02.01.2019 of District Consumer Disputes Redressal Forum Jalaun (hereinafter referred to as District Forum) in Consumer Complaint (CC) no. 20 of 2016 was challenged, inter alia praying for setting aside the order dated 20.11.2024 of the State Commission.
2. While the Revision Petitioner (hereinafter also referred to as OP) was Appellant before the State Commission and OP before the District Forum, the Respondent (hereinafter also referred to as Complainant) was Respondent before the State Commission and Complainant before the District Forum.
3. Notice was issued to the Respondent on 18.02.2025 Parties filed Written Arguments/Synopsis on 08.09.2025 (Petitioner) and 04.09.2025 ( respondent) respectively.
4. Brief facts of the case, as emerged from the RP, Order of the State Commission, Order of the District Forum and other case records are that husband of complainant Ramlakhan Prajapati obtained a Jeevn Anand Insurance Policy for sum assured of Rs.4,00,000/- and the complainant Shree Kunwar was the nominee of the said policy. Under the said policy, the annual premium of Rs.25,227/- was to be deposited. It is the case of the complainant that her husband fell ill and he was taken to Grant Medical College and Sir J.J.Group of Hospital, Mumbai, whereupon he died on 04.11.2014. Further, it is the case of the complainant that at the time of purchase of policy, husband of complainant was not suffereing from any RP/289/2025 Page 2 of 12 disease, which fact her husband mentioned in the policy form, The complainant submitted a claim before the Insurance Company which was rejected by the Insurance Company. Being aggrieved of the said rejection of the claim, the complainant preferred CC before the District Forum and District Forum vide order dated 02.01.2019 partly allowed the complaint of the complainant. Being aggrieved of the said order of the District Forum , the OP filed an appeal before the State Commission and the State Commission modified the order of the District Forum by reducing the rate of interest from 9% to 6%. However, rest of the District Forum was maintained by the State Commission. Therefore, the Petitioner is before this Commission now in the present RP.
5. Petitioner has challenged the said Order dated 20.11.2024 of the State Commission mainly on following grounds:
(i) State Commission wrongly concluded that the PTCA Stenting and LAD are non surgical process which was not a material fact and such it is not necessary to disclose the same in the proposal form. Information regarding angioplasty, which the deceased had undergone in 2003, was given by none other than the patient himself to the treating doctor at Grant Medical College, Hospital, Mumbai.
(ii) From a bare perusal of the medical history stated in the certificate of the treating doctor of the deceased, it is clear that deceased was known case of Ischemic heart disease for past 12 years with PTCA ( Percutaneous transluminal Coronary Angioplasty) with Stenting of LAD done in 2003 before being admitted to the Grant Medical College, J J Group of Hospital, Mumbai and while giving history of illness, the deceased patient had told the attending doctors of Grant Medical College Hospital that he had undergone Angioplasty in 2003. The information which has been recorded RP/289/2025 Page 3 of 12 by the attending doctor in the column 'past history' would be based on the disclosure made by the patient himself and as per section 58 of the Evidence Act, the respondent was estopped from pleading that same were not material facts. In coloumn titled 'personal history', the deceased disclosed to the attending doctor that he is chronic beedi smoker.
(iii) State Commission failed to appreciate that deceased deliberately and fraudulently gave wrong answers to the questions in the proposal form, more specifically questions 11 (iv), 11 (v) and 11
(vii). The deceased was a known case of Ischemic heart disease for the past 12 years before being admitted to the Grant Medical College, J.J.Group of Hospital, Mumbai.
(iv) State Commission failed to appreciate that PTCA with stent procedure is considered to be a material information that needs to be disclosed by the insured when applying for a life insurance policy as it indicates a pre-existing medical condition that could impact the life expectancy of the insured and therefore affect the premium charged or even the eligibility for coverage. Even the deceased suppressed information about her past illness. (V) State Commission failed to appreciate the true import of Section 45 of the Insurance Act, 1938 ( pre amended) which makes it clear if life assured dies within two years of taking the policy, then Insurance Company has to show that fact stated by the insured in the proposal form was inaccurate or false without having to prove that the same was material to disclose or that same was made fraudulently.
(vi) State Commission failed to appreciate the law laid down by the Hon'ble Supreme Court in various judgments that what is material or not is to be adjudged by the Insurance Company and not the insured. Counsel relied on the judgment of the Hon'ble Supreme Court in Satwant Kaur vs. New India Assurance Co. (2009) SCC RP/289/2025 Page 4 of 12
(vii) State Commission failed to appreciate that deceased suppressed the information about the past illness ( angioplasty) fraudulently and deliberately and the information about the health of the deceased was in exclusive knowledge of the deceased and her family and the Petitioner Corporation could not have known about it even after reasonable enquiry.
(viii) The State Commission committed an error by not taking into consideration the meaning and content of 'material' as stipulated under the provisions of Insurance Regulatory and Development Authority ( Protection of Policyholders' Interests) Regulations, 2002.
(ix) Information which was considered vital to be given to the treating doctor for symptom of chest pain and breathlessness was not found material to be disclosed to an insurance company that was sharing the risk of loss of the deceased's life. The State Commission failed to appreciate that Ischemic heart disease since 12 years with PTCA ( percutaneous transluminal Coronary Angioplasty) with stenting of LAD were considered material and serious enough by the hospital to be mentioned continuously in the bed-head ticket as well as the medical certificate. (X) State Commission committed an error by shifting the burden of proof on the petitioner instead of respondent. Once it was admitted by the respondent that deceased had undergone surgeries that were not disclosed in the proposal form, the onus to explain that there was no nexus between the previous surgeries /illness with cause of death had shifted on the respondent which she failed to discharge.
(xi) In the contract of insurance, mere suppression and inaccuracy of facts stated in the proposal form, whether or not having nexus with the cause of death are enough to vitiate the entire contract of insurance.
RP/289/2025 Page 5 of 12(xii) State Commission failed to appreciate that contract of insurance is based on 'uberrima tides'. The deceased was under legal obligation to act with utmost faith towards the Petitioner corporation and make full disclosure of facts that are exclusively within her knowledge.
(xiii) While challenging the order of the State Commission, the Petitioner has relied on the following judgments of the Hon'ble Supreme Court:
a. Mithoolal Nayak Vs. Life Insurance Corporation of India AIR 1962 SC 814 b. Satwant Kaur Vs New India Insurance Co. (2009) 8 SCC 316 c. LIC & Ors. Vs. Asha Goel and Anr. (2001) 2 SCC 160 d. P.C.Chacko and Anr. Vs.Chairman, LIC AIR 2008 SC 424 e. Reliance Life Insurance Co. Ltd. Vs. Rekhaben Nareshbhai Rathod 2019 6 SCC 175 f. United India Ins.Co. Ltd. Vs. Samir Chandra Choudhary (2005) 5 SCC 784
6. Heard counsels of both sides. Contentions/pleas of the parties, on various issues raised in the RP, Written Arguments, and Oral Arguments advanced during the hearing, are summed up below.
6.1 Counsel for the Petitioner apart from repeating the points which have been stated in para 5 argued that deceased was constantly monitored by the doctors in the hospital. Counsel also relied on the judgment of this Commission in Bhupendra Singh Bhatia Vs. Regional Manager, Life Insurance Corporation of India & Anr. - RP No. 2568 of 2023 decided on 16.01.2025. Counsel for the Respondent argued that the instant RP is not maintainable in its present form and facts and circumstances of the case and the Petitioner is estopped from seeking relief under the provisions of Consumer Protection Act, 2019. Further, the instant RP is barred by limitation as Hon'ble Supreme Court in many cases observed that insurance companies are refusing claims RP/289/2025 Page 6 of 12 in many cases on filmsy grounds and they should not be too technical. It is also argued that Petitioner wrongly interpreted Section 45 of the Insurance Act, 1938. Counsel for the respondent relied on the following judgments of the Hon'ble Supreme Court / National Commission a. Gurmel Singh Vs. National Insurance Co. Ltd. 2022 SCC Online SC 666 b. Neelam Chopra and Ors. Vs. Life Insurance Corporation of India and Ors. 2018 CPJ 321 (NC) c. Hari Om Agrawal Vs. Oriental Insurance Co. Ld. Writ Petition ( C) No. 656 of 2017 decided on 17.09.2007 c. Sulabha Prakash Motegaonkar and Ors. Vs. Life Insurance Corporation of India 2021 13 SCC 561 decided on 05.10.215
7. Vide order dated 20.11.2024, the State Commission has partly allowed the appeal filed by the Petitioner herein by modifying the rate of interest from 9% to 6% and rest of the order of the District Forum was upheld. Earlier, District Forum vide its order dated 02.01.2019 allowed the complaint with following reliefs:
Complaint is partly allowed. Opposite parties are ordered that they shall pay the insurance death benefits of Rs.4,00,000/- to the complainant within a period of 60 days, moreover, they shall also pay simple interest @ 9% per annum on the aforesaid amount from the date of filing complaint i.e. 25.07.2016 till the date of actual payment. In the circumstances of present case, both the parties shall bear their respective costs.
8. The claim was repudiated by the Petitioner - Insurance Co. vide repudiation letter dated 15.03.2016 primarily on the ground of suppression of material facts with respect to pre existing ailment. In support of their contentions, they have relied upon the medical record of Grant Medical College and Sir J J Group of Hospitals, who under the column ' past history' records as follows:
IC/C/O, IHD since 12 years and PTCA with stenting of LAD done in 2003.RP/289/2025 Page 7 of 12
> Counsel for the Petitioner Insurance Co. admits that other than these documents, they do not have any other medical record pertaining to angioplasty done in 2003.
9. Relevant portion of the repudiation letter is reproduced below:
, Re- Death Clnim under Pbl. No.235827281issue(l on the life " ot Late RAM IAKHAN PRAJAP ATI With reference to your claim unde: the above policy on the life of your deceased husband we have to inform you that we have decided to repudiate all ijj^itjc^nderihe policy on account of the deceased having with-helc material informatiorf regardingTTs health at the time of ^*"S/h^nSeaten wc have t0 jn ^rm you that in the Proposal for Assurance dated 29/04/2012 signed by the deceased assured h'e had answered the following questions as under noted Answers Questions '"fl writ xsrarff it No
(i) snust ms vif 3-fcur <v*rcr w® ctnre airaswJxH t?
arobY roft m ^bwih , w ftnn xrore ftter w fafr ftafr No (IQ trar ;
sreoatcT m it 5WT £ ?
4E nff ■ZROTSidt f^Tft ?t5T it 'BSft No
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tftf&f t or vh ww dlfet $ ?
No
(v) IMir 3IFT TOPfc, 31R, 3«7fi(wr TKT -^r=r, snre& fixtf, afar amaiL xMt wr wsit arerar fcraft srs®! ii^r \ o 'tr iftf ww 'flfcr t 7
(c) w snu faeet1 .. uif xjnr •jsrnew wnt re sn^ ®i?f «cs argfl^eia vfc $
(ix) wwpzztr: ami^ ^Rar sit feufSr %? • Good We may, however, state that these answers were false as the OLA HAD CHRONlC^BJPlZSMOKER ..Bl)TL;i'HE§E«FACTS.w\YEl<EJJSOTw,DISCLOSED_lb HIS PROPOSAL FORM. , . j m. i -u It is therefore, evident that he had made deliberate mis-statements and with-held material information from us regarding his health at the time of affecting the assurance and hence in terms of the Policy Contract and the Declarations contained m the tonns of Proposal tor Assurance, we hereby repudiate the claim under the above policy RP/289/2025 Page 8 of 12
10. A bare perusal of the repudiation letter and the questions contained in the proposal form show that the first question itself asks the details about diseases in the last 5 years and another question asks about absence from place of work on ground of health during last five years, although some other questions in between asks questions for an indefinite period. While we agree with the questions, which are asked for a specific period prior to the taking of the policy with respect to the pre-existing ailments, it seems unfair to ask some questions for an undefined/indefinite period prior to filling of proposal form. To take an example of a question under para 6(ii) as stated in the repudiation letter, which asks the question- "have you ever been admitted to any hospital or nursing home for general check-up, observation, treatment or operation", a person at a particular age taking such policy is expected to give reply to this question since his birth, which many people may not even remember their hospitalization during their childhood days. Further, in the light of two questions, out of 6 mentioned in the repudiation letter, which seek information only for last 5 years, it is natural for the person filling the form to assume that all such questions seek information only for the last 5 years. Hence, in the present case, even if assuming for arguments sake that the deceased/insured had a past history of IHD and have undergone PTCA with stenting of LAD done in 2003, this is much prior to the last 5 year's period from the date of proposal.
11. No doubt, suppression of material facts with respect to pre-existing ailments entitles the insurance company to repudiate the claim, but as has been laid down by the Hon'ble Supreme Court in Life Insurance Corporation of India vs. Smt. G. M. Channabasamma (1991) (1) SCC 357, the onus to prove such suppression of material fact is on the Insurance Company. In the present case, except for the medical record of Grant Medical College and Sir J.J. Group of Hospitals, which record the medical history as stated in para 8 above, the Insurance Company has not placed on record any reliable and cogent evidence to show that the deceased was suffering from such diseases RP/289/2025 Page 9 of 12 and/or was undergoing any treatment for the same. If, as alleged by the Insurance Company, the deceased/insured was a case of IHD since 12 years and PTCA with stenting LAD done in 2003, they ought to have placed on record some reliable medical records/treatment records of the deceased in support of their allegation of suppression of material facts. The mere mention under the past history is not a sufficient evidence to prove suppression of material facts with respect to pre-existing ailments. Moreover, there is no evidence on record to show whether the deceased/insured was suffering from any ailments in the past 5 years from the date of proposal form, details of which he suppressed in the proposal form.
12. The District Forum considered all these aspects at length, rejected the contentions of the Insurance Company and partly allowed the Complaint. Extract of relevant paras of the District Forum's order are reproduced below:
xxxxx "6. Normally, what has been usual state of health?? - Good.
Admittedly the deceased Policy Holder undergone treatment in Grant Medical College & Sir J. J. Group of Hospital, and passed away during treatment. The Medical Forms and Bed Head Ticket related to deceased were obtained. According to Bed Head Ticket, the cause of death was shown to be "Terminal Cardiorespiratory arrest due to type of respiratory failure due to cardiogenic chock c/o Ishchemic Heart Disease". In the Bed Head Ticket, this fact is also mentioned that in the year 2003, PTCA with Stenting of LDA was done. After perusal of all the facts, it was found by the Opposite Parties that the material informations related to health were concealed by the Policy Holder, on the basis of which, Complainant's Insurance Claim was rejected, which is proper. Deceased Policy Holder fraudulently obtained Policy by concealing the facts. On this ground, the Insurance Claim has been rightly rejected. Complainant is not entitled to receive any amount. Therefore, the Complaint is liable to be dismissed.
Arguments of Ld. Counsel for both the parties were heard by the Forum, and all the evidences available on record were perused.
RP/289/2025 Page 10 of 12Ld. Counsel for the Opposite Parties and Complainant have also submitted the written arguments on record. On behalf of the Opposite Parties, Certified copy of Insurance Policy of Policy Holder, certified copy of Bed Head Ticket of Grant Medical College & Sir J. J. Group of Hospitals, have also been produced on record. Ld. counsel for the Opposite Parties mainly argues on this point that deceased Policy Holder was suffering from heart disease and in the year 2003, his PTCA Stenting & LDA was done and this fact was concealed by the deceased Insurance Policy Holder. These facts have been mentioned in the Patient History Column in the said Bed Head Ticket. It has been further mentioned that deceased was not suffering from Diabetes, T.B. and RVD. Now, it has to be seen that whether not giving information related to health about 12 years ago, would be fatal for the Complainant for receiving Insurance Claim". PTCA Stenting and LAD is a Non-Surgical Process and no direct evidence available on record to this effect whether it was done in the year 2003 or not, this fact has been mentioned only in Patient History. Even thereafter, for the sake of moment, if it is accepted that Non-Surgical Process was exercised on the deceased Policy Holder, then, it was not such an important information, which is required be necessarily provided to the Insurance Company. In the year 2003, aforesaid process was adopted and Insurance Policy was purchased after 09 years thereof. In the meanwhile, no such evidence has come on record to this effect that deceased Insurance Policy Holder was ailing and he remained admitted in Hospital or received consultation with any doctor. Even though, in Proposal form, the questions related to any ailment or admission in hospital since last 05 years was asked, which was replied by the deceased Policy Holder in No. On perusal of Bed Head Ticket, it is clear that on 04.11.2014 at about 4.45 a.m. in the morning, he was admitted in Hospital and in the same Bed Head Ticket, this fact is mentioned that deceased started feeling breathing problem on 04.11.2014 after morning, and started suffering from chest pain afternoon, and thereafter, he was admitted on 04.11.2015, and on 04.11.2014 at 2.30 p.m. in noon, deceased Policy Holder died. It appears that deceased Policy Holder died all of sudden. Insurance Policy was availed on 25.04.2012, whereas, Policy Holder died after 02 years i.e. on 04.11.2014."
13. After careful consideration of the orders of the State Commission, District Forum, other relevant records and rival contentions of the parties, we are of the considered view that both the Fora below have passed well-
RP/289/2025 Page 11 of 12reasoned orders. Although we may not agree with some of the observations of the District Forum with respect to PTCA Stenting and LAD being a non- surgical process, we are in agreement with its final findings and do not find any reason to interfere with their findings. We also uphold the orders of the State Commission vide which rate of interest has been reduced from 9%, as granted by the District Forum, to 6%.
14. Accordingly, Revision Petition No. 289 of 2025 is dismissed. All the pending lAs, if any, also stand disposed off.
Sd/-
( DR. INDER JIT SINGH ) I
PRESIDING MEMBER
Sd/-
( DR. SUDHIR KUMAR JAIN, J.) .
MEMBER
Am/AB
RP/289/2025 Page 12 of 12