JUSTICE V.K.JAIN, PRESIDING MEMBER (ORAL) Late Sh. Subhash Bhupendrabhai Dixit took an insurance policy from the respondent for a sum assured of Rs.20,00,000/-. He having died on 26.12.2009, a claim was preferred by the appellant for payment of the benefit available under the insurance policies taken by her deceased husband. The claim however, was repudiated vide letter dated 08.02.2010 which to the extent it is relevant, reads as under: “This has reference to your claim dated Nil, received by us on 19th January 2010 for the benefits under the above policy. We have carefully considered your claim; but have decided to repudiate our liability under the policy for the following reasons: The above policy was issued on the basis of an application for insurance dated 18th March 2009 by Mr. Subhash Bhupendrabhai Dixit (the “Life Assured”) on his own life. In the said application the Life Assured had replied in negative to the questions numbered VIII (A) & (B). We are reproducing below the aforesaid questions and the replies thereto: “VIII Insurance History of the Life to be Insured (A) Is there any application submitted or pending or do you have any other Insurance Policies in effect with BSLI or any other insurer? Application No. | Policy No. | Name of the Insurer | Date Applied | Year Issued | Sum Assured | | | LIC of India | | 1992 | 1,00,000 |
(B) Has any application for insurance on your Life to BSLI or any insurer been declined, deferred, dropped or accepted at special terms? ..........No. However, our investigations have established that the Life Assured had taken several Policies on his life from other Insurance Companies before he submitted his application for insurance to Birla Sun Life Insurance Company Ltd. and hence the reply to questions No. VIII (A) is not true. Further our investigations have also established that the Life Assured’s application for insurance has been declined by at least one of the insurer and also another proposal on his life has been postponed prior to his application for insurance to the Birla Sun Life Insurance Company Ltd. and hence the reply to question No. VIII (B) in the application for Insurance submitted to BSLI is false. Had all the above facts been disclosed correctly and truthfully in the application for insurance, the Company would not have issued the policy at all. Hence we are hereby repudiating your claim for the benefits under the policy.” 2. Being aggrieved from repudiation of the claim, the appellant approached the concerned State Commission by way of a Consumer Complaint. The complaint was resisted on several grounds including the ground on which the claim had been repudiated. 3. The State Commission having dismissed the Consumer Complaint, the appellant is before this Commission by way of this appeal. 4. As held by the Hon’ble Supreme Court in ‘Galada Power and Telecommunication Limited Vs. United India Insurance Company Limited & Anr.’ (2016) 14 SCC 161, the insurer cannot be allowed to travel beyond the ground on which the claim is repudiated. Therefore, the only grounds given in the repudiation letter for repudiation of the claim were required to be tested in this Consumer Complaint. 5. The respondent, in para V(b) of the written version to the Consumer Complaint, alleged that several insurance policies had been taken by the deceased from other insurance companies such as Kotak Life Insurance, ING Life & Reliance Insurance. Copies of all the mails alleged to be received from the said insurance companies were annexed as Exhibit- C to the written version filed by the respondent. Since copy of Exhibit-C has not been filed by either party, it is not possible to know what exactly were the contents of the said document. However, what is material is that neither the complainant admitted the other policies alleged to have been taken by her deceased husband from other insurers nor did the insurer lead any evidence to prove the other policies alleged to have been taken by the deceased from other insurance companies. The State Commission, in my opinion, ought to have given an opportunity to the respondent to prove the insurance policies alleged to have been taken by the deceased husband of the complainant from other insurers and the complainant ought to have been given an opportunity to rebut the evidence so produced by the respondent. 6. It is also alleged in the repudiation letter that an application of the deceased for grant of insurance cover had been declined by at least one of the insurers whereas another proposal on his life had been post-poned. No evidence was led by the respondent to prove the said averment made in the repudiation letter. The respondent needs to be given an opportunity to prove the said averments made in the repudiation letter and the complainant needs to be given an opportunity to rebut the evidence if any, produced by the respondent to prove the said assertion made in the repudiation letter. 7. During the course of arguments, my attention was drawn to the letter dated 20.05.2010 sent by Gitaben B. Chapatwala, who filled the proposal form to the respondent company. In the said letter, she stated that she had asked the client to disclose all other insurance policies but she told her that the details of all the policies were with his C.A. In my opinion, it would be necessary to examine Gitaben B. Chapatwala to find out as to why she did not record in the proposal form that though the deceased had obtained the other insurance policies, the details of the said policies were available with his C.A. After recording her statement, the State Commission also needs to go into the question as to whether the respondent would be bound by the act of Smt. Gitaben B. Chapatwala or not. 8. For the reasons stated hereinabove, the impugned order is set aside and the matter is remitted back to the State Commission to decide the complaint afresh after giving opportunity to the parties to lead evidence in terms of this order and after examining Smt. Gitaben B. Chapatwala. Smt. Gitaben B. Chapatwala will be examined as a Court Witness and both the parties will be given an opportunity to cross-examine her. 9. Considering the age of the case, the State Commission is directed to decide the complaint afresh within three months of the parties appearing before it. The parties are directed to appear before the concerned State Commission on 18.04.2019. | 
