Insurance claims cannot be repudiated without clear evidence of the insured's concealment of material facts at the time of policy issuance.

The present Appeal has been filed against the order dated 01.03.2018 in Complaint No. 193 of 2015, whereby the complaint was dismissed.

2. Brief facts of the case are that one Sucha Singh ( deceased ) during his life time obtained life insurance policy namely HDFC SL Progrowth Flexi bearing no.14556985 from the respondent for a period of 10 years for sum assured Rs.55,00,000/-. The date of commencement of policy was 31.08.2011. The annual premium of the policy was Rs.5,50,000/-. The premium amount was regularly paid by the insured. After a short illness, the insured died in the hospital on 25.03.2014. The complainant being the nominee of the insured submitted his claim along with the relevant documents with the respondent but the respondent vide letter dated 17.03.2015 repudiated the claim. The claim was filed alleging therein that the repudiation was on fictitious and false grounds. He also alleged that he learnt that only a sum of Rs.23,30,875.99/- was credited in his account on 23.03.2015 towards death claim instead of making full amount of the total assured sum. The prayer was made seeking direction to the respondent to make the payment of sum assured with interest @ 18% p.a. from the date of death of insured and also Rs.2,00,000/- towards mental agony and Rs.25,000/- towards litigation expenses.

3. The claim was contested by the respondent. They had filed their written version. It is alleged that complaint was liable to be dismissed as there was no deficiency in service on their part. It was contended that the insurance policy so provided to the insured was a Linked Policy. He made investment in the share market as per the policy applied for and the returns of the policy were based on the share market. It was also contended that the insured had concealed the fact that he was suffering from chronic liver disease prior to the issuance of the policy and that he was a chronic alcoholic. During investigation these facts were established. He was also diagnosed having chronic liver disease, hepatitis-B and hepatitis-C. Such type of diseases happens when a person drinks heavily for a decade or more. A sum of Rs.23,30,875/- had been paid to the complainant as per terms and conditions of the insurance policy being Unit Fund Value. This amount was paid as per settlement on 14.03.2015. It is not disputed that policy was of sum of Rs.55,00,000/-. On these contentions, it had been submitted that claim be dismissed.

4. Parties led their evidences before the State Commission. The Complainant had filed 9 documents which included affidavit, letter dated 03.09.2021, death certificate of insured, certificate of illness, letter dated 17.03.2015, declaration, letter dated 23.03.2015 and legal notice. The respondent has submitted affidavit of his Deputy Manager Amit Khanna and filed medical record / history of insured issued by Arpana Hospital, death claim investigation report, unit linked proposal form, terms and conditions of the policy, policy revival letter issued by HDFC Standard Life Insurance Company Limited, policy servicing request form 1, form J, death claim-further requirement, letter dated 17.03.2015 regarding death claim.

5. After hearing arguments of the learned counsel for the parties and perusing the relevant record, the State Commission reached to the conclusion that since insured was suffering with chronic liver disease and hence repudiation was justifiable.

6. This order is challenged by the complainant on the ground that stand taken by State Commission is based on conjectures and surmises and the respondent had not