2026 Supreme(Online)(NCDRC) 459

NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION
J. Rajendra, Presiding Member, Anoop Kumar Mendiratta, Member
Reliance General Insurance Co. Ltd. – Appellant
Versus
Harjinder Singh – Respondent
FIRST APPEAL NO. 315 OF 2020 | FIRST APPEAL NO. 420 OF 2020 | FIRST APPEAL NO. 266 OF 2022 | CONSUMER COMPLAINT NO. 1756 OF 2018

An insurer cannot repudiate an accidental death claim based on alleged pre-existing diseases without evidence of prior medical treatment or proof that such facts were knowingly suppressed. Furthermore, insurance companies cannot introduce new grounds for repudiation that were not explicitly included in their original rejection correspondence.

Headnote:(A) Consumer Protection Act, 1986 - Section 17 - Personal Accident Insurance - Repudiation of claim on grounds of non-disclosure and cause of death - Multiple policies taken by insured - Burden of proof rests upon insurance companies to establish that deceased suffered from pre-existing disease and that such information was knowingly suppressed - Mere existence of ailments in post-mortem report without evidence of prior treatment is insufficient to justify repudiation - (Paras 31, 44, 46)

(B) Insurance Law - Principles of Uberrimae Fidei - Material suppression - For a contract of insurance to be voided due to suppression, the fact suppressed must be material and within specific knowledge of the proposer - (Paras 45, 46)

(C) Evidence - Appellate jurisdiction - Insurance company cannot introduce new grounds for repudiation at appellate stage that were not mentioned in original letters of repudiation - (Para 47)

Facts of the case:
Claims were filed by the successor of the deceased following a fatal accident involving a two-wheeler. Insurance companies repudiated the claims, primarily arguing that the death was caused by pre-existing illnesses like heart and lung diseases rather than accidental injuries, claiming suppression of material facts, and noting that the deceased had obtained multiple accident policies within a short duration. The state commission allowed the complaints, leading to appeals by the insurers.

Findings of Court:
The documents provided, including the post-mortem report and police records, sufficiently established that the death was accidental. The insurance companies failed to produce evidence of prior medical treatment or prove that the deceased intentionally suppressed material health information. Further, taking multiple insurance policies is not prohibited by law, and insurers are bound by the grounds stated in their initial repudiation letters.

Issues: Whether the death resulted solely and directly from an accident, whether there was material suppression of health conditions at the time of policy inception, and whether the procurement of multiple insurance policies invalidates the claims.

Ratio Decidendi: The court maintained that an insurer must prove that an insured had prior knowledge of an ailment and intentionally suppressed it for a claim to be lawfully repudiated. In the absence of medical records or proof of prior treatment, external injuries resulting from a road accident must be accepted as the proximate cause of death. Furthermore, appellate bodies cannot consider grounds for repudiation not originally specified in the rejection letters.

Result: Appeals dismissed; complaint case allowed with directions for payment of assured sums with interest.