IMPORTANT POINT
Insurance – Materiality of a certain fact is to be determined on a case-to-case basis – However, burden of proving fact which excludes liability of Insurer to pay compensation lies on Insurer alone and no one else.

JUDGMENT :

(Satish Chandra Sharma, J.)

1. Leave Granted.

2. The present appeal is arising out of order dated 28.05.2019 passed by the National Consumer Disputes Redressal Commission, New Delhi, (for short, “the National Commission”) in First Appeal No. 1963 of 2018 dismissing the appeal preferred by the present appellant against the order dated 27.09.2018 passed by the Consumer Disputes Redressal Commission, Rajasthan, Jaipur (for short, the “State Commission”) by which the claim of the present appellant was rejected on account of suppression of material facts.

3. The facts of the case reveal that the father of the appellant – Ramkaran Sharma had obtained an insurance policy from the respondent – Exide Life Insurance Co. Ltd. on 09.06.2014 and unfortunately, died in an accident on 19.08.2015. The present appellant being the son of late Ramkaran Sharma submitted a claim for payment of benefits under the policy; however, the said claim was repudiated vide letter dated 03.03.2016. The claim was repudiated on the ground that there was material suppression by the father of the appellant while applying for insurance policy and respondents have relied upon the terms and conditions of Exide Life My Term Insurance Plan (UIN-114N063V01) in rejecting the claim. The appellant being aggrieved by repudiation of the claim submitted a complaint before the State Commission and the claim was dismissed vide order dated 27.09.2018 on the grounds that while submitting the proposal, the deceased insurer had disclosed only one policy taken by him from Aviva Life Insurance whereas he had concealed other insurance policies which he had taken from the Life Insurance Corporation of India and were in force at the time the insurance cover was sought.

4. The appellant being aggrieved by the order of the State Commission preferred an appeal before the National Commission, but the National Commission dismissed the appeal placing reliance on the judgment delivered by this Court in the case of Reliance Life Insurance Co. Ltd. & Anr. v. Rekhaben Nareshbhai Rathod, (2019) 6 Supreme Court Cases 175 and Satwant Kaur Sandhu v. New India Assurance Co. Ltd., (2009) 8 SCC 316.

5. Learned counsel for the appellant has vehemently argued before this Court that the orders passed by the State Commission as well as the National Commission deserve to be set aside as there was no material suppression on the part of his father while obtaining a life insurance policy from the respondent company. It is further argued that it was not a policy relating to any Mediclaim nor any material fact regarding health was suppressed, however, inadvertently, the policies issued by Life Insurance Corporation of India were not mentioned under clause 54 which is a mere omission as his father has mentioned about another policy issued by Aviva in clause 54. It has also been argued that the format of the application form was filled up by the agent and all necessary information was provided to the agent of the company and, therefore, if there is some omission, it should not amount to suppression of material fact, as in the present case the death has occurred on account of accident and not on account of any illness. Learned counsel for the appellant has also placed reliance upon the judgment delivered in the case of Mahakali Sujatha v. Branch Manager, Future Generali India Life Insurance Company Limited & Another, (2024) 8 SCC 712 and has prayed for setting aside the order dated 27.09.2018 passed by the State Commission and order dated 28.05.2019 passed by the National Commission.

6. On the other hand, learned counsel for the respondent insurance company while opposing the contentions of the appellant has vehemently argued before this Court that the insurance company was justified in repudiating the claim on account of material suppression on the part of the father of the appellant as at the relevant point of time, he was holding four policies; i.e. one issued by the Aviva and three issued by the Life Insur