ORDER

A.P. Sahi, President.—The Complainant Appellant filed CC No. 137 of 2016 raising a challenge to the rejection of an Insurance claim raised by the Appellant that was repudiated on 29.03.2016 by the Respondent Insurance Company. The repudiation letter is extracted hereinunder:

2. The Complainant also made a request for reconsideration before the Claims Review Committee which was also declined on 30.05.2016 that is extracted hereinunder:

Dear Sir,

Ref: DT15160781/01170139/CLREPIL

Sub: Your letter for reconsideration of claim under Policy No. 01170139

This is in reference to your letter received by us on 21.04.2016, in relation to claim under Policy No. 01170139.

We wish to inform you that your request was put up to the Claims Review Committee. After careful examination of the case, the Committee has upheld the earlier decision of the Company and has decided that your request cannot be acceded.

If the decision of the Committee is not agreeable to you, you may write to the Insurance Ombudsman at the following address:

Insurance Ombudsman

Office of the Insurance Ombudsman 62, Forest Park

Jeevan Bhawan, Phase 2,

6th floor, Nawal Kishore Rd. Hazratganj,

Lucknow-226 001

Tel.:0522-2201188

Fax: 0522-2231310

E-mail: ioblko@sancharnet.in

Thanking you,

Yours sincerely.

For Future Generali India Life Insurance Co. Ltd.,

Authorized Signatory

3. The facts in brief are that the Appellant’s son, late Om Narayan had acquired a policy from the Respondent Insurance Company for an assured sum of Rs.40 lakhs through a proposal form filled up on 04.12.2013. The policy was of Life Insurance (Basic Scheme policy) valid for 30 years. The Complainant Appellant was a nominee in the policy.

4. According to the Appellant, before the second premium could be paid that was due on 30.06.2014, the insured while riding on a tractor fell down and was crushed to death under its wheel. An FIR was lodged at Police Station Nautanwa, District - Mahrajganj, U.P. and the inquest report was prepared and the post-mortem done, whereafter the investigation was carried out and a charge sheet was filed against the tractor driver before the Court concerned.

5. The Appellant who was the nominee under the policy staked his claim but the Insurance Company on its enquiry came to the conclusion that the insured was holding other policies as on the date of the proposal, and the details of such policies were deliberately suppressed and not disclosed in the proposal form. This non-disclosure amounted to a suppression and accordingly, the claim was repudiated on the ground as referred to in the repudiation letter as extracted hereinabove.

6. Learned Counsel for the Appellant, Mr. Gupta has vehemently urged that the proposal form had been filled-up by the insured by endorsing the letters “N.A” against column No. 6.1 of the policy. Mr. Gupta submits that if the Insurance Company was not satisfied or had any doubt about the said answer given by the Insured, it was an obligation on them to have sought clarification from the insured if the Insurance Company was of the opinion that an improper reply had been given. He developed this argument with the aid of the law summarised by the Apex Court in the case of Mahakali Sujatha v. Branch Manager, Future Generali India Life Insurance Co. Ltd. & Anr., IV (2024) SLT 325 : SCC OnLine SC 525. Paragraph 30 of the said decision is extracted hereinunder:

30. The basic rules to be observed in making a proposal for insurance may be summarised as follows:

(a) A fair and reasonable construction must be put upon the language of the question which is asked, and the answer given will be similarly construed. This involves close attention to the language used in either case, as the question may be so framed that an unqualified answer amounts to an assertion by the proposer that he has knowledge of the facts and that the knowledge is being imparted. However, provided these canons are observed, accuracy in all matters of s