Late Smt. Sunita Devi obtained a life insurance policy from the respondent for a sum assured of Rs.1 lakh. She allegedly died on 18.1.1998 on account of she having fallen down from stairs in her own house on 15.1.1998 and having sustained several injuries. A claim for payment of benefits available under the  insurance policy was submitted by the complainant/appellant to the respondent. The claim, however, was repudiated vide letter dated 29.10.1998 which to the extent it is relevant reads as under:-

We may however, stated that all these answers were false as we hold indisputable proof to show that about 1 year before she proposed for the above policy she had suffered from Kochi’s Chest and was having pregnancy of more than 32 weeks for which she had consulted a medical practitioner and had taken treatment from him in a hospital. She did not however disclose these facts in her proposal form. Instead she gave false answers therein as stated above.

It is therefore evident that she had made deliberate misstatements and withheld material information from us regarding her health at the time of effecting the assurance and hence in terms of the policy contract and the declarations contained in the forms of Proposal for Assurance, we hereby repudiate the claim and accordingly we are not liable for any payment under the above policy and all moneys that have been paid in consequence thereof belong to us.”

2.      Being aggrieved from the repudiation of the claim, the petitioner approached the concerned District Forum by way of a consumer complaint.

3.      The complaint was resisted by the respondent primarily on the grounds on which the claim had been repudiated.

4.      The District Forum having allowed the complaint, the respondent approached the concerned State Commission by way of an appeal. Vide impugned order dated 15.11.2012, the State Commission allowed the appeal filed by the respondent and consequently dismissed the complaint. Being aggrieved, the petitioner is before this Commission.

5.      It would be seen that the only ground for repudiation of the claim was that the deceased was suffering from Kochi’s Chest which she had not disclosed while obtaining the insurance policy.

6.      In Sulbha Prakash Motegaonkar & Ors. Vs. LIC of India [Civil Appeal No.8245 of 2015] decided by the Hon’ble Supreme Court on 5.10.2015,   the husband of the complainant had, at the time of taking the policy from LIC of India, concealed the fact that he was suffering from Lumbar Spondylitis with PID with Sciatica for which he was taking medical treatment and had also availed medical leave. He suffered myocardial infarction and succumbed to the said ailment. The claim lodged by the complainant, however, was repudiated on the ground that the deceased had not disclosed the ailment of Lumbar Spondylitis with PID with Sciatica at the time of submitting the proposal. Allowing the complaint, the Hon’ble Supreme Court interalia held as under:-

“It is not the case of the Insurance Company that the ailment that the deceased was suffering from was a life threatening disease which could or did cause the death of the insured. In fact, the clear case is that the deceased died due to ischaemic heart disease and also because of myocardial infarction. The concealment of lumbar spondilitis with PID with sciatica persuaded the respondent not to grant the insurance claim.

We are of the opinion that the National Commission was in error in denying to the appellants the insurance claim and accepting the repudiation of the claim by the respondent. The death of the insured due to ischaemic heart disease and myocardial infarction had nothing to do with his lumbar spondilitis with PID with sciatica. In our considered opinion, since the alleged concealment was not of such a nature as would disentitle the deceased from getting his life insured, the repudiation of the claim was incorrect and not justified.”

7.      There is no evidence of the deceased having died on account of Kochi’s Chest. The case of the petitioner is that the deceased had succumbed to the injuries which she had sustained when she fell from the stairs of her house. The learned counsel for the respondent states that the injuries sustained by her were not serious enough to cause her death and in support of his contention, he relies upon the decision of this Commission dated 11.1.2013  passed in F.A. No.665 of 2017 inter-se between the same parties. In my view, what is relevant for the purpose of deciding this petition is as to whether Kochi’s Chest by itself was a dreaded disease which could have caused death of the insured or whether the deceased had died on account of she suffering from Kochi’s Chest. Neither there is an allegation nor even any evidence to prove that the deceased had died on account of her suffering from Kochi’s Chest. Even if it is presumed for the sake of arguments that she had not succumbed to the injuries which she sustained when she fell from the stairs, the fact remains that the claim could not have been denied unless it was shown that she had died on account of suffering from Kochi’s Chest. No material has been placed before this Commission to show that Kochi’s Chest  by itself was a life threating disease even at the time when the deceased insured is alleged to have died. The onus was upon the insurer to prove either that the deceased insured had died on account of she suffering from Kochi’s Chest or that Kochi’s Chest was by itself a life threating disease. Therefore, relying upon the decision of the Hon’ble Supreme Court in Sulbha Prakash (supra),  I hold that the repudiation of the claim was not justified.

8.      For the reasons state hereinabove, the impugned order is set aside and the respondent is directed to pay the sum assured of Rs.1,00,000/- (One lac) to the complainant, alongwith interest on that amount @ 9% p.a. from the date of institution of the complaint till the date of payment.  The revision petition stands disposed of.