The repudiation of a life insurance claim based on alleged concealment of health and suicide requires substantial evidence; taking medical leave does not inherently establish a serious ailment, and a Class I heir is entitled to pursue a claim for insurance benefits.

ORDER

(Per: Ms. Kumkum Rani, President):

1. This appeal under Section 41 of the Consumer Protection Act, 2019 has been directed against the impugned judgment and order dated 09.06.2023 passed by learned District Consumer Disputes Redressal Commission, Champawat (hereinafter to be referred as “The District Commission”) in consumer complaint No. 04 of 2014, styled as Smt. Manju Giri Vs. Divisional Manager, Life Insurance Corporation of India, Divisional Office, Haldwani, wherein and whereby the consumer complaint was allowed and the appellants / opposite party (insurance company) were directed to pay Rs. 4,50,000/- (the sum assured of all the three life insurance policies held by late Harish Giri, the deceased husband of respondent / complainant – Smt. Manju Giri) to the respondent / complainant; Rs. 40,000/- towards mental agony and Rs. 10,000/- towards litigation expenses along with interest @6% p.a., within a period of three months’ from the date of impugned judgment and order, failing which, the award amount was to carry interest @7% p.a. on the expiry of period of three months’.

2. The facts giving rise to the present appeal, in brief, are, as such that late Harish Giri, the deceased husband of respondent / complainant, died on 20.06.2009 due to burn injuries. During his lifetime, late Harish Giri had obtained three life insurance policies bearing policy No. 241611427 for sum assured of Rs. 1,05,000/- on 15.02.2008; policy No. 241611429 for sum assured of Rs. 1,05,000/- on 15.02.2008 and policy No. 241611808 for sum assured of Rs. 1,05,000/- on 08.05.2009. Upon death of the life assured, his father – Sh. Kishan Giri (father-in-law of the complainant) lodged claim with the insurance company for payment of the sum assured and submitted all the required documents. The insurance company, on the basis of hearsay evidence of Sh. Puran Lal Verma and Sh. Pramod Tamta, stated that the life assured had died due to fire burn injuries, whereas the life assured died due to sudden fire. The complainant submitted affidavit of Sh. Puran Lal Verma and Sh. Pramod Tamta with the insurance company, wherein they have stated that they have never given any such statement to any person / official of the insurance company. The insurance company asked for postmortem report of the life assured and police investigation report on 03.12.2013, which were duly submitted. However, the insurance company through letters dated 23.03.2013 wrongly repudiated the claim in respect of policy Nos. 241611427 and 241611429 on the ground that the deceased life assured was suffering from illness since long prior to his death. The complainant again submitted death claim with the Regional Manager, Life Insurance Corporation of India, Regional Office, Kanpur, but to no avail. Thereafter, the complainant through her counsel sent legal notice dated 03.01.2014 to the insurance company, which was replied by the insurance company through letter dated 15.01.2014, wherein it was stated that the claim has already been repudiated by the insurance company. Thus, the consumer complaint was set in motion by the complainant before the District Commission.

3. The appellant – insurance company filed written statement before the District Commission and pleaded that the deceased life assured had died due to suicide, hence as per the terms and conditions of the insurance policy, the insurance company was not liable to satisfy the claim and the insurance company has rightly repudiated the claim.

4. The District Commission, after hearing learned counsel for the parties and after taking into consideration the material available o