The insured's duty to disclose pre-existing conditions at the time of signing the proposal form in life insurance contracts is of utmost significance, impacting the validity of claims.

JUSTICE A.P. SAHI, PRESIDENT

1. This Appeal has been filed by the Life Insurance Corporation assailing the Order of State Consumer Disputes Redressal Commission, Uttar Pradesh in CC No. 83 of 2015, whereby the Complaint of the Respondent for award of an indemnification of Rs. 37 lakhs along with 7% interest has been allowed with a further direction to pay Rs. 10,000/- as litigation costs.

2. The Complaint had been filed after the claim of the coverage under the Life Insurance Policy in respect of the late husband of the Complainant was declined, who died on 19.06.2011. It was repudiated by the Insurance Company on 20.12.2012. A departmental Appeal against the same was preferred before the Appellate authority of LIC that was also dismissed on 01.08.2013. The Complainant was the nominee and the duration of the policy was till 19.02.2037. The insured was about 38 years of age when the said policy was taken in 2010.

3. The repudiation recites that the insured had suppressed the fact of the pre-existing disease and the treatment taken for stone in the kidney which facts have emerged after going through the medical documents and, therefore, the claim was liable to be repudiated. The repudiation letter dated 20.12.2012 is extracted hereinunder:

4. As noted above, the repudiation was upheld even on an Appeal before the Senior Divisional Manager, vide a communication dated 29.03.2014.

5. It is questioning the said repudiation that the said Complaint was filed urging that the Insured had absolutely no knowledge of any such pre-existing disease nor he was suffering or had any treatment, as such there was no question of suppression of any such fact at the time of filling up of the proposal form.

6. The Complainant came-up with a case that the insured never had any such symptoms and for the first time on 10.02.2011, he consulted a Homeopathic doctor namely Dr. Anurag Shrivastav, who on that day diagnosed the presence of two stones, one of 4mm size and the other of 2 mm size in the kidney. The pain in the back side and lower abdomen etc. was also noted in the said prescription, which is Annexure – 6 on record. It is almost four months thereafter that the insured was admitted on 18.06.2011 in Sahara Hospital, Lucknow at about 7.00 am and he died the next day on 19.06.2011. The Complainant took a stand that the insured was treated for his ailment and the cause of death recorded by the hospital was cardio respiratory arrest. It was, therefore, also the contention of the Complainant which has been accepted by the State Commission that the cause of death had no connect with any stones in the kidney and the death not being on account of any excluded ailments in the policy, the claim was clearly indemnifiable and payable.

7. It was contended by the Complainant before the State Commission that the proposal form does indicate an answer in the negative against column no. 11(4) regarding any ailment of the kidney or existing ailment of the kidney, but since there was no such ailment known to the Complainant or even diagnosed or treated, therefore, there was no suppression of any fact and hence, the repudiation is based on an erroneous consideration and against the weight of evidence on record. In short there was no evidence to substantiate a pre- existing or antecedent ailment.

8. The State Commission accepted this contention and recorded its finding that the documents relied on for the past