An insurance company cannot repudiate a claim based on alleged suppression of pre-existing diseases without providing cogent, independent evidence of prior medical treatment or the insured's documented awareness of such conditions before the policy inception.

KIRAN SIBAL, MEMBER

The instant appeal has been filed by the appellant/opposite party against the impugned order dated 18.07.2022 passed by District Consumer Disputes Redressal Commission, Ludhiana (in short, “the District Commission”), whereby the complaint filed by complainant against opposite party (in short ‘OP’), under the Consumer Protection Act, was allowed while granting the following relief:-

“9. Consequently, the complaint of the complainant is decided in his favour. Complainant is awarded Rs.2,00,000/- as insurance amount along with interest @12% per annum from the due date till its payment. The complainant is also awarded Rs.1,00,000/- as compensation on account of mental and physical harassment with Rs.33,000/- as litigation expenses……….”

2. It would be apposite to mention that hereinafter the parties will be referred, as have been arrayed before the District Commission.

3. Brief facts for the disposal of the appeal are that the complainant after the death of his father; namely, Sh. Ramesh Chander, since deceased(hereinafter referred as DLA), came to know that his father had taken a life insurance policy from the OP and he paid the first premium on 26.03.2004. Thereafter, the DLA had been regularly paying the premium quarterly upto his death i.e. on 11.04.2005. The complainant further stated that after the death of his father, a death claim was lodged by his mother, but the same was rejected by the OP. The mother of the complainant was pursuing the matter with the OP, but she also died on 17.03.2007 and the complainant, who was minor at that time, was taken by his maternal uncle to reside with him at Jalandhar. The complainant after attaining the age of majority, filed consumer complaint before the District Commission and sought directions against the OP to pay claim amount to the tune of Rs.5,00,000/- along with compensation and cost of litigation.

4. Upon notice OP appeared through counsel and filed written reply, wherein it raised certain preliminary objections, which are not required to be reproduced here for the sake of brevity. On merits, OP stated that the father of the complainant had obtained an insurance policy bearing No.00348040 for a tenure of 20 years starting from 01.03.2004 against the sum assured of Rs.2,00,000/-. After the death of his father, her mother lodged death claim under the policy with the OP, who duly registered, entertained and processed the claim. However, from the investigations, it was established that the life assured was suffering from Tuberculosis (TB) prior to issuance of the policy and the said fact was not disclosed by him in the proposal form. Accordingly, the death claim was repudiated after due consideration and intimation in this regard was sent to the mother of the complainant, vide letter dated 13.01.2006. The OP further stated that after the death of his mother, the complainant again filed an application on 24.01.2008, which was duly signed by complainant and Sh. Vijay Kumar Sharma as his guardian, for reconsideration of the claim and the said letter was duly replied by OP on 23.02.2008 in terms of the repudiation letter dated 13.01.2006. As such, the complaint of the complainant was hopelessly time barred. After denying the other averments made in the complaint, OP prayed for dismissal of the complaint.

5. The parties led their evidence before the District Commission in support of their respective contentions and the District Commission af