IMPORTANT POINT
Insurance—Repudiation of death claim on the ground of concealment of disease must be supported with reliable and cogent evidence.

ORDER

Gautam Chourdiya, President—This appeal is filed under section 41 of the Consumer Protection Act 2019 (hereinafter referred to as “the Act” for short) against order dated 14.08.2024 passed by District Consumer Disputes Redressal Commission, Kanker (C.G.) (hereinafter called “District Commission” for short) in complaint case No.CC/02/2024, whereby the complaint was allowed and the opposite parties/ appellants herein were directed to pay the amount of insurance claim of death of insured husband of the complainant/ respondent Rs.50,00,000/- (Fifty Lacs) along with simple interest @ 7% p.a. from the date of filing complaint 27.12.2023 within one month, failing which the interest was directed to be paid @ 9% p.a. The opposite parties/ appellants were further directed to deposit within one month penalty of Rs.10,000/- (Ten Thousand) in the Consumer Welfare Fund and to pay Rs.10,000/- (Ten Thousand) to the complainant/ respondent towards compensation for mental agony and sufferings along with cost of litigation Rs.3,000/- (Three Thousand).

2. In nutshell the facts of the case, as stated in the complaint, are that the complainant/ respondent’s husband Shravan Kumar Salam had taken two insurance policies No.5300488070707 and 45351802602, issued on 31/12/2015 and 03/09/2019 respectively, from opposite parties/ appellants insurance company, in which he had made his wife Smt. Savitri Salam the nominee. On 16/06/2021, the complainant/ respondent’s husband died due to sudden worsening of health during the corona epidemic. Claim was made before the insurer opposite parties/ appellants under both the insurance policies, but insurance claim of insurance policy No.45351802602 was rejected saying that the life assured had concealed his diabetes disease, whereas the deceased life assured Shravan Kumar Salam died as he was tested corona positive. Deceased Shravan Kumar Salam had filled the proposal form on 28/12/2015, at that time he did not have any disease, he was completely healthy and after four years, he filled the proposal form for taking the second policy on 03/08/2019, at that time also he was healthy, he did not have any disease. The opposite parties/ appellants insurer paid the sum insured of policy No.53004880707 out of the insurance claim made by the complainant/ respondent, but when the insurance claim under policy No.45351802602 was not settled, the complainant/ respondent sent a legal notice through his advocate on 06/05/2022, to which the opposite parties/ appellants insurance company replied on 27/05/2022 and informed that the policy holder Shravan Kumar Salam was suffering from diabetes at the time of insurance and refused to pay the insurance claim. Hence, the complaint was filed before the District Commission seeking direction for the opposite parties/ appellants insurer to pay sum assured of Rs.50,00,000/- (Rupees Fifty Lakhs) along with interest and other reliefs from the opposite parties under the insurance policy taken by her deceased husband.

3. The opposite parties / appellants insurance company in their written version denied all the allegations leveled in the complaint and averred inter alia that based on the information given in the proposal form and relying on the information believed to be true and accurate, the proposal form was accepted in utmost good faith and SBI Life Smart Shield Policy No.45351802602 was issued with commencement date 03/09/2019. The policy was issued for a basic sum assured of Rs.50,00,000/- (Rupees Fifty Lakhs). In the present case the insured answered all the questions in the medical questionnaire in negative. A medical examination of the proposed life assured was also conducted but during the medical examination also the insured answered all the relevant questions in the negative. The available records prove that the deceased life assured (DLA) concealed the fact that he was suffering from Diabetes Mellitus and Heart Disease and was undergoing treatment before the date of signing the p