1.         The present Revision Petition (RP) has been filed by the Petitioners against Respondents as detailed above, under section 21 (b) of Consumer Protection Act 1986, against the order dated 01.01.2018 of the State Consumer Disputes Redressal Commission, Uttar Pradesh (hereinafter referred to as the ‘State Commission’), in First Appeal (FA) No. 779 of 2004 in which order dated 28.02.2004 of District Consumer Disputes Redressal Forum, Bijnaur (hereinafter referred to as District Forum) in Consumer Complaint (CC) No. 6 of 2002 was challenged, inter alia praying for setting aside the order dated 01.01.2018 of the State Commission.

2.         While the Revision Petitioner(s) (hereinafter also referred to as Complainant) was Respondent before the State Commission and Complainant before the District Forum and the Respondent(s) (hereinafter also referred to as Opposite Party) were Appellants before the State Commission in FA/779/2004 and Respondent before the District Forum in Complaint No. 6/2002.

3.         Notice was issued to the Respondent(s) on 20.12.2018.  Parties filed Written Arguments on 12.01.2024 (Petitioner) and on 25.04.2023 (Respondent). 

4.         Brief facts of the case, as presented by the Complainant and as emerged from the RP, Order of the State Commission, Order of the District Commission and other case records are that: -

(i)        Shri Mukhtiyar Singh, the Petitioner’s/Complainant’s real uncle, obtained an insurance policy worth Rs.1 lakh from R-1/OP with policy number 251586535.

(ii)       Due to the absence of an age certificate, Shri Mukhtiyar Singh provided an affidavit and a medical certificate to OP-1, on basis of which OP-1 issued the policy on 29.10.1997 with a premium of Rs.4954/-.

(iii)     Shri Mukhtiyar Singh paid the specified premium and nominated the Complainant, he died of a brain hemorrhage on 22.12.1997. The OP-1 was informed on 28.01.1998.

(iv)      The Complainant, being the nominee, is entitled to the insurance claim. The Complainant submitted the necessary claim form and application to OP-1.

(v)       Despite providing all requested documents and information, the Complainant did not receive the claim payment from the OPs.

(vi)      The OPs asked for the age certificate of Mukhtiyar Singh's children, but he had nothing to show. Consequently, the OPs refused to process the claim despite receiving all required documents at the time of policy issuance. A notice sent to the OP on 10.5.2001 went unanswered.

(vii)    The Complainant made multiple visits to the offices in Bijnaur and Meerut but received no clear response regarding the claim payment. The OPs are legally obligated to pay but have failed to do so, leading the complainant to file the suit.

(viii)   The cause of action arises from the Complainant being the nominee, the submission of a claim application, and the non-payment of the claim, falling within the jurisdiction of the Hon'ble Court.

(ix)      District Forum allowed the complaint and directed the OPs to make payment of policy of insured to the Complainant within 30 days as per rules with interest @6% per annum.

(x)       On the other hand, State Commission allowed the appeal of the OPs and set aside the order of the District Forum and directed the parties to bear their respective costs of this Appeal.

5.         Vide Order dated 28.02.2004, in the CC No. 6 of 2002 the District Commission has allowed the complaint and passed the following order:

“Complaint of the complainant against the defendants is decreed. It is ordered to the defendants to make payment of policy of insured (Policy-holder) Mukhtiyar Singh to the complainant within 30 days as per rules. It is also ordered to the defendants to pay interest also at the rate of six percent per annum on the total payable amount from 01.03.2002 to the complainant within thirty days.”

6.         Aggrieved by the said Order dated 28.02.2004 of District Commission, Petitioner(s) appealed in State Commission and the State Commission vide order dated 01.01.2018 in FA No. 779 of 2004 has allowed the appeal of the Respondent herein:

“          Appeal is allowed. The complaint, by setting aside the impugned judgement and order dated 28.02.2004 passed in the complaint no. 06/2002 by the District Forum, Bijnaur, is dismissed. 

Both the parties shall bear their respective costs of this Appeal.       

It is directed to the Registrar to ensure sending one copy of the Judgement to the Chairman, Life Insurance Corporation, Yogkshem Building, Jiwan Bima Marg, Mumbai for taking action against the agent concerned and against the Doctor concerned of Panel of the Life Insurance Corporation.

Certified copy of this judgement be provided to both the parties as per rules.”     

7.         Petitioner(s) have challenged the said Order dated 01.01.2018 of the State Commission mainly/inter alia on following grounds:

(i)        The State Commission failed to appreciate that the age proof of the life assured was not available hence affidavit is submitted by him as well he was medically and physically examined and after the report of the doctor the insurance coverage was granted, this internal report is not submitted by the LIC neither the doctor or agent is examined, however the State Commission solely on the accusation of the respondent decided the case against the revisionist.

(ii)       The State Commission did not appreciate that the element of fraud and misrepresentation is to be proved and corroborated by evidence, in this matter neither the repudiation letter dated 27.02.2002 stated that fraud and collusion is committed by the life assured, nor any inquiry under the rules is done by the LIC, thus on the basis of statement of the respondent the appeal is allowed and the complaint case of the revisionist is dismissed.

(iii)     The State Commission failed to appreciate that the respondent did not accuse their doctor as well as their agent in the written statement submitted before the District Consumer Forum, however the Commission observed that the doctors and agent colluded and rejected the complaint case of the revisionist.

(iv)      The State Commission ignored that the claim is submitted with the insurance company on 28.10.1998 and after the complaint case is filed before the DCF it is repudiated on 27.02.2002 that is after a time lag of three and a half years as such the LIC is liable for the commission the deficiency in service and is accountable to pay Punitive Damages.

8.         Heard counsels of both sides.  Contentions/pleas of the parties, on various issues raised in the RP, Written Arguments, and Oral Arguments advanced during the hearing, are summed up below.

            8.1       In addition to the averments made under the grounds (para 7), the petitioner contended that DLI had submitted an affidavit with regard to the age proof and also examined by the doctor of the Respondents medically and physically. After satisfying the age and medical fitness of the DLI, certificate of fitness is issued by the doctor of the Respondents. Based upon the fitness certificate, the Respondents issued the policy in question to DLI. In view of the above petitioner relied upon the following judgements:

(i)   Reliance Life Insurance Company Ltd. & Anr. Vs. Kanaram in

       RP/1134/2017 vide order dated 10.10.2017.

(ii)  Assistant Director, Postal Service & Anr. Vs. Basta Ram in

       RP/2098/2016 vide order dated 26.10.2016.

(iii) Life Insurance Corporation of India & Anr. Vs. Gopal Singh in

       RP/370/2007 vide order dated 28.01.2011.

8.2       On the other hand Respondent contended that DLI had concealed the true information regarding his age. On 22.10.1997, in his proposal form, date of birth shown as 10.10.1947 and age 50 years, which is completely wrong and baseless. DLI was not 50 years old on the date of proposal. DLA expired on 22.12.1997 within 2 months of taking policy and it was found that in the voter list the age of DLA was 70 years, thus DLA concealed the material fact of his age and falsely disclosed his age as 50 years whereas he was about 72 years of age as per voter list at the time of taking of policy. In support of his contentions, Respondent relied upon the following judgements:

                        (i)   LIC Vs. Kusum Patro in RP/1585/2011 vide order dated 19.03.2012

                        (ii)  Satwant Kaur Sandhu Vs. New India Assurance 2009 (8) SCC 316

                        (iii) Branch Manager, Bajaj Allianz Vs. Dalbir Kaur 2020 AIR (SC) 5210.

                          (iv) LIC Vs. Hira Devi in RP/4048/2009

(v)  Lakhbir Kaur & Ors. Vs. LIC in RP/1840/2014 vide order dated 16.12.2014

(vi) LIC Vs. Minu Kalita III 2002 CPJ 10 NC.

9.         In this case, the claim has been repudiated on the ground of suppression of material fact in the proposal form with respect to age, the date of birth mentioned in the proposal form is 10.10.1947 and the age on the nearest birthday is 50 years, while according to investigation done by the insurance company, the age of the deceased was about 80 years. In support of their case before the lower fora, insurance company has placed reliance on the voter list of the year 1995 i.e. two years prior to the insurance of the policy, as per which the age of the DLI was about 70 years. Hence, his age at the time of taking policy is approx.72 years. The Insurance Company contends that life insured policies are generally not issued to the persons aged above 60 years except in certain specified categories. Had the DLI correctly declared his age, possibly Insurance Company, could not have issued the policy. The age mentioned in the proposal form is based on the self-declaration. The policy in question was issued on 20.11.1997 with effective date 28.10.1997, the insured died on 22.12.1997 i.e. less than two months’ time from the date of start of issuance of the policy. As per intimation dated 21.8.1998 given to the Insurance Company, the insured died a sudden death at home due to brain hemorrhage.

10.       The Insurance Company has also relied upon a certificate dated 30.7.1998 issued by the doctor under whose treatment, the deceased was, according to which the age of the deceased was about 80 years. The Insurance Company further contended that the complainant was specifically asked to supply a copy of family register/ Voter list but they informed vide their reply dated 2.3.2000 that the deceased never lived at any place permanently due to which he was not having any vote right at any place, stating further that copy of family register is not available. Insurance company has also drawn our attention to the proposal form under which the complainant herein, Mr. Jatinder Kumar, who is also nominee under the policy has been shown as son of the DLI and same thing is mentioned in the reply dated 2.3.2020. However, in the complaint before the District Forum they have taken the plea that the DLI was uncle of the complainant herein and not the son. There are no records with regard to family members of the deceased.

11.       We have carefully gone through the orders of the State Commission, District Forum, other relevant records and rival contentions of the parties. The State Commission after due appreciation of the evidence placed on record by the parties have concluded that there was suppression of material fact with respect to age of the deceased in the proposal form and the Insurance Company was justified in repudiating the claim on this ground. In this regard extract of the relevant paras of the orders of the State Commission is given below:

“On perusal of the records available at the case file, it comes in light that on making demand by the appellant, the respondent informed about unavailability of any voter list related to the policy-holder, however, the appellant filed true photocopy of the voter list related to the policy- holder of the year 1995 of during investigation proceedings. This is not the Statement of the respondent that the voter list issued by the appellant is forged. As far as the question of age shown in this voter list is concerned, this voter list is prepared by the competent Government officers on the basis of information provided by the voters concerned. In these circumstances, as no other fact is proved, entry of this voter list cannot be considered suspicious. The respondent did not produce any such evidence, on the basis of which, age of the policy-holder mentioned in the voter list may be considered suspicious. The appellant has filed true photocopy also of the Affidavit of Dr. V.K. Mittal, who conducted medical examination of the policy-holder on dated 21.12.1997 and true photocopy of the medical documents, in which, age of the policy-holder is shown about 80 years. This is not the Statement of the respondent that on dated 21.12.1997, Dr. V.K. Mittal did not conduct medical examination of the policy-holder. In these circumstances, on perusal of the records produced by the appellant, it is clear that while getting Insurance Policy in question, actual age of the policy-holder was above 70 years, however, in the proposal letter related to the policy in question, the policy-holder showed his age 50 years itself. Therefore, this Statement of the appellant deserves to be accepted that the Policy-holder deceitfully received the Insurance Policy by concealing substantial facts related to his age.

This is certainly quite unnatural that despite showing their age 50 years by the person of the age above 70 years, the insurance agent and Doctor who conducted medical examination had no knowledge about this cheating by the policy- holder. The appellant, in the grounds of appeal, has himself admitted that the insurance agent concerned and Doctor, who conducted medical examination, colluded with the policy-holder and got issued Insurance Policy in question but it is surely unfortunate that despite knowledge of this fact, the appellant Insurance Corporation did not provide any information about the action taken in this regard against the insurance agent and the Doctor concerned. Only by allowing the Insurance Claim, they considered as they have discharged their duty. It is required from the appellant Insurance Corporation to ensure appropriate action against the insurance agent concerned and the Doctor concerned under intimation in this regard to the Commission as well.”

We are in agreement with the observations and findings of the State Commission. There is no illegality or material irregularity or jurisdictional error in the orders of the State Commission. It has been held by Hon’ble Supreme Court in catena of judgements[1] that non-disclosure/suppression of material facts in the proposal form entitles the Insurance Company to repudiate the claim.

12.       For the reasons stated hereinabove, and after giving a thoughtful consideration to the entire facts and circumstances of the case, various pleas raised by the learned Counsel for the Parties, orders of the State Commission is upheld and the RP is dismissed.

13.       The pending IAs in the case, if any, also stand disposed off.