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2026 DAILYLAW 543 (KER)

Life Insurance Corporation of India v. Suja Harikumar

2026-05-19

Anil K Narendran, Muralee Krishna S

body2026
JUDGMENT : Muralee Krishna, J. This writ appeal is filed by the petitioners in W.P.(C) No.5497 of 2025, invoking the provisions under Section 5(i) of the Kerala High Court Act, 1958 , challenging the judgment dated 19.08.2025 passed by the learned Single Judge in that writ petition. For convenience of reference, the parties are referred to in this judgment by their status in the writ petition. 2. The husband of the 1 st respondent was an agent of the Life Insurance Corporation of India (‘LIC’ for short). He took a cancer cover policy of LIC and was issued with Ext.P1 policy document with the commencement date 14.11.2017. Ext.P2 is the proposal of the said date submitted by the husband of the 1 st respondent for availing the policy. The husband of the 1 st respondent was diagnosed with hepatocellular carcinoma on 16.08.2019, and was succumbed to that illness on 16.09.2019. Thereafter, the 1 st respondent, being the widow and nominee of the insured, submitted a claim under the policy before the 1 st petitioner. By Ext.P3 letter dated 27.12.2019, the claim of the 1 st respondent was repudiated by the 1 st petitioner on the ground of suppression of material facts regarding the treatment and health condition of the insured in the proposal form. Aggrieved by the repudiation of the claim, the 1 st respondent preferred an appeal to the 2 nd petitioner. But by Ext.P4 letter dated 16.03.2020, the 2 nd petitioner upheld the decision of the 1 st petitioner. 2.1. Aggrieved by Exts.P3 and P4, the 1 st respondent preferred Ext.P5 O.P.No.10147 of 2020 before the Permanent Lok Adalat, invoking the provisions under Section 22(a)(b)(vi) of the Legal Services Authorities Act . The petitioners entered appearance before the Permanent Lok Adalat and filed a written statement contending that there was suppression or non- disclosure of relevant material facts relating to the health condition of the policyholder, which, if disclosed, the LIC would not have issued the policy in the normal course of business. 2.2. The petitioners entered appearance before the Permanent Lok Adalat and filed a written statement contending that there was suppression or non- disclosure of relevant material facts relating to the health condition of the policyholder, which, if disclosed, the LIC would not have issued the policy in the normal course of business. 2.2. By Ext.P10 award dated 24.09.2024, the Permanent Lok Adalat allowed the petition filed by the 1 st respondent and directed the LIC to pay the entire amount of Rs.35/- Lakhs under the policy within three months from the date of receipt of a copy of the award, failing which the award amount will carry interest @ 9% from the date of award till realisation and further directed the LIC to pay a sum of Rs.35,000/- per month for a period of ten years from the date of the award. Being aggrieved, the petitioners approached this Court by filing W.P.(C)No.5497 of 2025 under Article 226 of the Constitution of India , seeking a writ of certiorari to quash Ext.P10 award of the Permanent Lok Adalat and to declare that the 1 st respondent was not entitled to any relief under the policy as directed in Ext.P10 award. 2.3. After hearing both sides, the learned Single Judge by the impugned judgment dated 19.08.2025 dismissed the writ petition. Paragraphs 10 to 14 and the last paragraph of that judgment read thus; “10. The main ground urged by the petitioners is that the insured did not reveal the fact that he was suffering from Aphthoid Ulcer, fatty liver and prostatomegaly in the proposal form. The Permanent Lok Adalat noted that Aphthoid Ulcer is a common ulcerative inflammatory condition inside the mouth or at the base of the gums which would heal without any treatment. The husband of the 1 st respondent was a teetotaler, and fatty liver is considered as not harmful. The Permanent Lok Adalat further concluded that the prostatomegaly is a common occurrence in men of a certain age and was considered part of the aging process in men. 11. On 12.08.2019, the husband of the 1 st respondent had a feeling of fever and went to AIMS for consultation. It was then that he was incidentally detected to have elevated transminasus. CT scan in abdomen revealed features of multricentric HCC and tumor thrombus. 11. On 12.08.2019, the husband of the 1 st respondent had a feeling of fever and went to AIMS for consultation. It was then that he was incidentally detected to have elevated transminasus. CT scan in abdomen revealed features of multricentric HCC and tumor thrombus. Within 34 days from the date of diagnosis on 16.11.2019, the husband of the 1 st respondent expired. 12. The Administrative Officer of the Claim Department of the 1stpetitioner was examined as RW1. During cross- examination, RW1 admitted that there is nothing in Ext.P7 which will indicate that Aphthoid Ulcer will come in the category of non-healing Ulcer. The Doctor, who diagnosed the disease with carcinoma, was examined as PW3. She gave evidence that 69% Malayalees are having fatty liver. Though fatty liver was noted on 04.04.2017, the deceased was diagnosed with liver cancer only on 12.08.2019. 13. It is to be noted that at the time of joining insurance, the deceased was required to reveal whether he was suffering from any non-healing Ulcer. Aphthoid Ulcer being a healing Ulcer, though may occur recurrently, one cannot conclude that there is suppression. The deceased, therefore, has not committed any mistake by not revealing the fact that he was having Aphthoid Ulcer in Ext.R1 proposal form (Ext.P2 herein). 14. The Permanent Lok Adalat has considered the entire evidence on records and has appreciated the evidence in the proper perspective. I do not find any illegality in Ext.P10 Award. Ext.P10 Award is not liable to be interfered on any of the grounds urged by the petitioners. The writ petition is therefore dismissed”. 2.4. Being aggrieved by the dismissal of the writ petition, the petitioners filed the present writ appeal. 3. Heard the learned counsel for the appellants-petitioners and the learned counsel for the 1 st respondent. 4. The learned counsel for the appellants-petitioners would submit that from Exts.P7 and P8 medical records produced along with the writ petition, it is evident that the husband of the 1strespondent was under treatment for aphthoid ulcer, fatty liver and prostatomegaly. He had been receiving treatment for aphthoid ulcer for the last 15 years, as noted in Ext.P7 gastro notes. This fact is suppressed in Ext.P2 proposal form submitted by him. He had been receiving treatment for aphthoid ulcer for the last 15 years, as noted in Ext.P7 gastro notes. This fact is suppressed in Ext.P2 proposal form submitted by him. As per question No.7 in Ext.P2 proposal form, the consultation, medical advice, investigation, surgery, treatment or noticing of any signs and symptoms of cancer, lump, swelling, growth nodes, cyst, tumour, non- healing ulcer and increase in size of number of moles anywhere in the body has to be disclosed. If that disclosure was made by the insured, the petitioners would not have accepted the proposal form and issued the policy. Therefore, it is material suppression on the part of the husband of the 1strespondent, who is the policyholder, which disentitles him to get the coverage under the policy. The Permanent Lok Adalat, as well as the learned Single Judge, failed to consider these aspects in their proper perspective. The learned counsel, in support of his arguments regarding suppression of material information in the proposal form, which entitles the insurance company to repudiate the policy, relied on the judgment of the Apex Court in Satwant Kaur Sandhu v. New India Assurance Company Ltd. [(2009) 8SCC 316] and Reliance Life Insurance Company Ltd. v. Rekhaben Nareshbhai [ (2019) 6 SCC 175 ] 5. The learned counsel for the 1 st respondent would argue that the policy to which the husband of the 1 st respondent joined is not the one that requires medical examination of the insured. Exts.P7 and P8 documents pertain to a full body check-up conducted by the insured, which is only a routine check-up. Aphthoid ulcer noted in Ext.P7 is an automatic healing one and not a non-healing ulcer. If such a non-healing ulcer were there, it would have found a place in Ext.P8 also. The experts examined before the Lok Adalat as PWs 2 and 3 clearly deposed that the ulcer noted in Ext.P7 is not a non-healing ulcer. Similarly, the fatty liver noted in Ext.P8, according to PW3, is present in 59% of Malayalees. If such a non-healing ulcer were there, it would have found a place in Ext.P8 also. The experts examined before the Lok Adalat as PWs 2 and 3 clearly deposed that the ulcer noted in Ext.P7 is not a non-healing ulcer. Similarly, the fatty liver noted in Ext.P8, according to PW3, is present in 59% of Malayalees. By pointing out the deposition of RW1 examined on the side of the insurance company, the learned counsel submitted that RW1 admitted that it was only after verifying the truthfulness of the entries in the proposal form, the policy was issued to the husband of the 1 st respondent and similarly, Ext.P7 does not show that the aphthoid ulcer is recorded as non-healing one in that document. 6. In Satwant Kaur Sandhu [ (2009) 8 SCC 316 ] , while considering the issue of non-disclosure of material particulars in a health insurance policy, the Apex Court held thus; “21. The upshot of the entire discussion is that in a Contract of Insurance, any fact which would influence the mind of a prudent insurer in deciding whether to accept or not to accept the risk is a "material fact". If the proposer has knowledge of such fact, he is obliged to disclose it particularly while answering questions in the proposal form. Needless to emphasise that any inaccurate answer will entitle the insurer to repudiate his liability because there is clear presumption that any information sought for in the proposal form is material for the purpose of entering into a Contract of Insurance’. (Underline supplied) 7. In Rekhaben Nareshbhai [ (2019) 6 SCC 175 ] , while considering the consequence of non-disclosure of a previous insurance cover under Section 45 of the Insurance Act , the Apex Court held thus; “26. Contracts of insurance are governed by the principle of utmost good faith. The duty of mutual fair dealing requires all parties to a contract to be fair and open with each other to create and maintain trust between them. In a contract of insurance, the insured can be expected to have information of which she/he has knowledge. This justifies a duty of good faith, leading to a positive duty of disclosure. The duty of mutual fair dealing requires all parties to a contract to be fair and open with each other to create and maintain trust between them. In a contract of insurance, the insured can be expected to have information of which she/he has knowledge. This justifies a duty of good faith, leading to a positive duty of disclosure. The duty of disclosure in insurance contracts was established in a King's Bench decision in Carter v Boehm , (1766) 3 Burr 1905, where Lord Mansfield held thus: “Insurance is a contract upon speculation. The special facts, upon which the contingent chance is to be computed, lie most commonly in the knowledge of the insured only; the underwriter trusts to his representation, and proceeds upon confidence that he does not keep back any circumstance in his knowledge, to mislead the under - writer into a belief that the circumstance does not exist, and to induce him to estimate the risque, as if it did not exist.” It is standard practice for the insurer to set out in the application a series of specific questions regarding the applicant's health history and other matters relevant to insurability. The object of the proposal form is to gather information about a potential client, allowing the insurer to get all information which is material to the insurer to know in order to assess the risk and fix the premium for each potential client. Proposal forms are a significant part of the disclosure procedure and warrant accuracy of statements. Utmost care must be exercised in filling the proposal form. In a proposal form the applicant declares that she / he warrants truth. The contractual duty so imposed is such that any suppression, untruth or inaccuracy in the statement in the proposal form will be considered as a breach of the duty of good faith and will render the policy voidable by the insurer. The system of adequate disclosure helps buyers and sellers of insurance policies to meet at a common point and narrow down the gap of information asymmetries. This allows the parties to serve their interests better and understand the true extent of the contractual agreement. The finding of a material misrepresentation or concealment in insurance has a significant effect upon both the insured and the insurer in the event of a dispute. This allows the parties to serve their interests better and understand the true extent of the contractual agreement. The finding of a material misrepresentation or concealment in insurance has a significant effect upon both the insured and the insurer in the event of a dispute. The fact it would influence the decision of a prudent insurer in deciding as to whether or not to accept a risk is a material fact. As this Court held in Satwant Kaur (supra) “there is a clear presumption that any information sought for in the proposal form is material for the purpose of entering into a contract of insurance”. Each representation or statement may be material to the risk. The insurance company may still offer insurance protection on altered terms”. (Underline supplied) 8. It is trite that, as held in Satwant Kaur Sandhu [ (2009) 8 SCC 316 ] , non-disclosure of any fact by the insured in the proposal form, which would influence the mind of a prudent insurer in deciding whether to accept or not to accept the risk, is a material fact that would adversely affect the claim of the insured. In this case, the point to be decided is whether there is any such non-disclosure of material fact that would affect the decision- making of the petitioners, in view of Exts.P7 and P8 documents of medical check-up. 9. Admittedly, the husband of the 1 st respondent availed the cancer cover policy on 14.11.2017 by submitting Ext.P2 proposal form. Clause 7 of the proposal form deals with the questions relating to health details and medical details. To all the questions under the said clause, the husband of the 1 st respondent answered in negative. Question No.7(vii)(a) and Question No.7(ix) in Ext.P2 are the relevant questions relied upon by the insurance company to argue that, in view of Exts. P7 and P8 documents, the answers given by the insured to those questions are suppression of material information. Those questions are as under; “7. Question No.7(vii)(a) and Question No.7(ix) in Ext.P2 are the relevant questions relied upon by the insurance company to argue that, in view of Exts. P7 and P8 documents, the answers given by the insured to those questions are suppression of material information. Those questions are as under; “7. Health details and Medical Information xxxx xxxx xxxx vii) Have you ever received consultation, medical advice, been investigated, undergone surgery or been treated or have noticed signs and symptoms for following: (a) Cancer, Lump, Swelling, growth, nodes, cyst, tumor, nonhealing ulcer and increase in size of number of moles anywhere in your body?” xxxx xxxx xxxx ix.Other than as a part of routine/executive/ pre employment checkup, Have you been advised to undergo any investigation in last 6 months like Ultrasound (USG) , body scan, MRI, CT scan, Cytology, pap smear, mammogram, colonoscopy, biopsy, blood tests, cancer/tumor markers? If yes, please provide details”. 10. To the above questions in Ext.P2, the proposer had answered “No”. Therefore, the point is whether, the above answer given by the husband of the 1 st respondent, will amount to non- disclosure of his true health condition or in other words is there any evidence to hold that he was suffering from any of the health conditions mentioned in question No.7(vii)(a) or underwent the tests mentioned in question No.7(ix) before the submission of Ext.P2 proposal form?. 11. It is relying on the entry in Ext.P7 that the husband of the 1 st respondent was suffering from an aphthoid ulcer for 15 years, the petitioners are taking a stand that he has not answered question No.7 truly by disclosing the non-healing ulcer. But, according to the 1 st respondent, Exts.P7 and P8 are reports pertaining to a routine health check-up. It is pertinent to note that Exts.P7 and P8 are the documents of the health check-up conducted by the husband of the 1 st respondent in the year 2019, whereas the policy was obtained by him in the year 2017, that is, prior to Exts.P7 and P8. 12. It is also pertinent to note that, except the entry in Ext.P7 that the husband of the 1 st respondent was suffering from aphthoid ulcer for 15 years, there is no evidence either before the Permanent Lok Adalat or before the learned Single Judge to hold the said ulcer as a non-healing one. 12. It is also pertinent to note that, except the entry in Ext.P7 that the husband of the 1 st respondent was suffering from aphthoid ulcer for 15 years, there is no evidence either before the Permanent Lok Adalat or before the learned Single Judge to hold the said ulcer as a non-healing one. On the other hand, evidence of PWs 2 and 3 before the Permanent Lok Adalat is that the aphthoid ulcer is a recurring one, and it is not a non-healing ulcer. 13. In order to understand the meaning of aphthoid ulcer, we have referred Taber’s Cyclopedic Medical Dictionary, 21 st edition, which defines ‘aphthoid’ as ‘resembling aphthae’, and ‘aphthae’ as ‘a small ulcer on a mucous membrane of the mouth, as in thrush’. 14. As noticed hereinabove, relying on the evidence of PWs 2 and 3, the Permanent Lok Adalat and the learned Single Judge arrived at a finding that the aphthoid ulcer is a common ulcerative inflammatory condition inside the mouth or at the base of the gums, which would heal without any treatment. As per question No.7(vii) (a) of Ext.P2, only if the aphthoid ulcer was a non-healing one, there is a requirement for disclosure of the same in Ext.P2 proposal form. When the evidence of PWs 2 and 3, the Doctors clearly suggest that the aphthoid ulcer noted in Ext.P70 is a recurring one, and not a non-healing one, neither the Permanent Lok Adalat nor this Court can arrive at a contrary finding by presuming otherwise. So also, there is no material to say that the fatty liver and prostatomegaly noted in Ext.P8 were suffered by the husband of the 1 st respondent at the time of availing the policy. Under those circumstances, it cannot be said that there is material suppression in Ext.P2 proposal form, which disentitles the policyholder to get the policy coverage. Therefore, we find no reason to differ from the finding of the Permanent Lok Adalat and that of the learned Single Judge that there is no material suppression on the part of the policyholder, that is, the husband of the 1 st respondent in Ext.P2 proposal form. Under such circumstances, needless to mention that the judgments in Satwant Kaur Sandhu [ (2009) 8 SCC 316 ] and Rekhaben Nareshbhai [ (2019) 6 SCC 175 ] have no application to the facts of the present case. Under such circumstances, needless to mention that the judgments in Satwant Kaur Sandhu [ (2009) 8 SCC 316 ] and Rekhaben Nareshbhai [ (2019) 6 SCC 175 ] have no application to the facts of the present case. Having considered the pleadings and materials on record and the submissions made at the Bar, we find no ground to hold the impugned judgment of the learned Single Judge as perverse or patently illegal, which warrants interference by exercising appellate jurisdiction. In the result, the writ appeal stands dismissed.