The burden of proving false representation and suppressed material facts lies on the insurer, and failure to discharge this burden renders the repudiation of the claim unjustified and amounts to deficiency in service.

Ms. Rumnita Mittal, Member—The present appeal has been filed assailing the order dated 9.11.1998, passed by District Forum-I, Tis Hazari, Delhi, in Complaint Case No. 1407/1998 (old) No. 2142/1994) - entitled Shri Harish Joshi v. Life Insurance Corporation of India.

2. The relevant facts, in brief are, that the respondent had filed a complaint before the District Forum with the grievance that his claim in respect of insurance policy No. 111445616 for Rs. 50,000/- had been wrongly repudiated by the appellant.

3. The wife of the respondent Smt. Beena Joshi had taken an insurance policy for Rs. 50,000/- commencing from 28.10.1991. However, Smt. Beena Joshi expired in R.B.T.B. Hospital, Kingsway Camp on 2.6.1993 and was diagnosed as suffering from pulmonary tuberculosis. Accordingly the respondent being the nominee in the policy filed a claim with the Insurance Company. The said claim of the respondent was repudiated by the appellant on the ground that the insured had concealed material facts relating to the pre-existing disease i.e. tuberculosis from which the insured was suffering at the time of taking out the policy on 17.10.1991. Accordingly, the respondent filed a complaint before the District Forum for the redressal of his grievance.

4. The stand of the O.P. in its reply/written version filed before the District Forum was that from the Medical Attendant’s Certificate, as well as, certificate of hospital treatment it was revealed that the assured had been suffering from pulomonary tuberculosis since July, 1988 and the said material fact had been concealed from the appellant at the time of taking the policy and that false answers had been given in the proposal form, especially to questions 17(a) and 18(a) and accordingly the repudiation of the claim of the respondent was justified in the circumstances and there was no deficiency in service in that regard on the part of the appellant.

5. The learned District Forum on the basis of the material on record held that the repudiation of the claim of the respondent was not justified and as such directed the appellant to pay the sum assured amounting to Rs. 50,000/- together with interest @ 12% p.a. from the date of repudiation i.e. 20.3.1995 till actual payment together with Rs. 1,000/- as cost of litigation.

6. Aggrieved by the aforesaid order the appellant/LIC has preferred the present appeal before this Commission.

7. We have carefully perused the documents/material placed on record, as well as, have deliberated upon the written submissions filed on behalf of both the parties. We have also heard the arguments advanced on behalf of the respondent as none was present on behalf of the appellant at the stage of arguments. The main thrust of the appellant in the present appeal is that the deceased assured had taken the insurance policy on the basis of statements and answers as well as declarations contained in the proposal form for insurance dated 12.10.1991 and that the said declarations formed the basis of the contract for insurance based on the principle of ‘uberrimaa fides’ i.e. utmost good faith. The insured had given false answers in the proposal form to the specific queries in column 17(a) and 18(a) which read as under :

17(a) - What has been your usual state of health ?

(a) - Good

18(a) - Have you ever suffered from or are suffering from; persistent cough, asthma bronchitis, pneumonia, pleurisy, spitting of blood, tuberculosis, or any other disease of lungs ?

(a) - No.

It is contended on behalf of the appellant that the above said statements in the proposal form of insurance policy were false to the knowledge of the appellant as is borne out of the Medical Attendant’s Certificate which was filed by the respondent itself before the District Forum. In answers to Clause 4(c) and (e) it was specifically stated that the respondent was suffering from the tuberculosis since July, 1988 and that the first symptoms of the disease were observed about five years back. Furthermore, the certificat