The burden of proving suppression of material facts in an insurance contract lies squarely on the insurer, requiring concrete evidence of the insured's illness or treatment during the relevant period, rather than relying solely on secondary medical history notations.

ORDER

1. The present Revision Petition (RP) has been filed by the Petitioner against the Respondent as detailed above, under section 58 (1) (b) of Consumer Protection Act 2019, against the order dated 20.11.2024 of the State Consumer Disputes Redressal Commission Uttar Pradesh (hereinafter referred to as the ‘State Commission’), in First Appeal (FA) No 173 of 2019 in which order dated 02.01.2019 of District Consumer Disputes Redressal Forum Jalaun (hereinafter referred to as District Forum) in Consumer Complaint (CC) no. 20 of 2016 was challenged, inter alia praying for setting aside the order dated 20.11.2024 of the State Commission.

2. While the Revision Petitioner (hereinafter also referred to as OP) was Appellant before the State Commission and OP before the District Forum, the Respondent (hereinafter also referred to as Complainant) was Respondent before the State Commission and Complainant before the District Forum.

3. Notice was issued to the Respondent on 18.02.2025 Parties filed Written Arguments/Synopsis on 08.09.2025 (Petitioner) and 04.09.2025 (respondent) respectively.

4. Brief facts of the case, as emerged from the RP, Order of the State Commission, Order of the District Forum and other case records are that husband of complainant Ramlakhan Prajapati obtained a Jeevn Anand Insurance Policy for sum assured of Rs.4,00,000/- and the complainant Shree Kunwar was the nominee of the said policy. Under the said policy, the annual premium of Rs.25,227/- was to be deposited. It is the case of the complainant that her husband fell ill and he was taken to Grant Medical College and Sir J.J.Group of Hospital, Mumbai, whereupon he died on 04.11.2014. Further, it is the case of the complainant that at the time of purchase of policy, husband of complainant was not suffereing from any disease, which fact her husband mentioned in the policy form. The complainant submitted a claim before the Insurance Company which was rejected by the Insurance Company. Being aggrieved of the said rejection of the claim, the complainant preferred CC before the District Forum and District Forum vide order dated 02.01.2019 partly allowed the complaint of the complainant. Being aggrieved of the said order of the District Forum, the OP filed an appeal before the State Commission and the State Commission modified the order of the District Forum by reducing the rate of interest from 9% to 6%. However, rest of the District Forum was maintained by the State Commission. Therefore, the Petitioner is before this Commission now in the present RP.

5. Petitioner has challenged the said Order dated 20.11.2024 of the State Commission mainly on following grounds:

(i) State Commission wrongly concluded that the PTCA Stenting and LAD are non surgical process which was not a material fact and such it is not necessary to disclose the same in the proposal form. Information regarding angioplasty, which the deceased had undergone in 2003, was given by none other than the patient himself to the treating doctor at Grant Medical College, Hospital, Mumbai.

(ii) From a bare perusal of the medical history stated in the certificate of the treating doctor of the deceased, it is clear that deceased was known case of Ischemic heart disease for past 12 years with PTCA ( Percutaneous transluminal Coronary Angioplasty) with Stenting of LAD done in 2003 before being admitted to the Grant Medical College, J J Group of Hospital, Mumbai and while giving history of illness, the deceased patient had told the attending doctors of Grant Medical College Hospital that he had undergone Angioplasty in 2003. T