5 min readNew DelhiUpdated: Mar 19, 2026 11:20 AM ISTThe testimony unravels the manner in which the insurance firm attempted to procure evidence to defeat a valid claim,” the national consumer body noted. (Image generated using AI)Consumer commission news: The National Consumer Disputes Redressal Commission (NCDRC) has set aside a 2014 order of the Chhattisgarh consumer panel and directed Birla Sun Life Insurance to pay Rs 48.92 lakh with interest to the family of a deceased policyholder, while holding that the claim was denied on the basis of “fake, procured and unethical” evidence.A bench of Justice A P Sahi (president), and Bharatkumar Pandya (member) was hearing an appeal against the state commission by the wife of a man who died within nine months of purchasing the insurance policy from the company, and held that the insurer failed to prove suppression of pre-existing illness.“This entire testimony unravels the manner in which the Insurance Company has attempted to procure evidence in order to defeat a valid claim.Also Read | Retired Mumbai couple wins Rs 2.83 crore consumer refund after decade-long battle over luxury flat ‘deception’“We thoroughly deprecate the practice of the Insurance Company and we find that the Insurance Company through this dubious method had succeeded in repudiating the claim which is clearly based on a fake and procured evidence. It is not only uncreditworthy but is also unethical,” said the national consumer commission on March 11.Why this ruling mattersThis judgment is significant for multiple reasons, including raising the bar on claim rejection, calling out investigative malpractices, strengthening consumer protection and clarifying evidentiary standards. Justice A P Sahi (NCDRC president) and Bharatkumar Pandya (member) was hearing an appeal against the state commission by the wife of a man who died within nine months of purchasing the insurance policy.Death within 8 months, claim deniedThe dispute traces back to March 28, 2009, when the family took out a life insurance policy of Rs 48.92 lakh.However, the insured man died on December 2, 2009, within 8.5 months of taking the policy.On March 4, 2010, the insurer rejected the claim, alleging non-disclosure of pre-existing ailments (hypertension, vertigo) and overstatement of income in the proposal form.The Chhattisgarh State Commission upheld this repudiation on April 30, 2014, prompting the appeal before the NCDRC.NCDRC: Insurer’s case built on ‘no evidence’The consumer commission found that the entire case of the insurer collapsed under scrutiny.Applying the principles of any prudent rule of evidence, this entire testimony unravels the manner in which the insurance company has attempted to procure evidence in order to defeat a valid claim.The doctor’s own affidavit contradicted his certificate.No medical records supported the allegation of illness.No tests, prescriptions, or hospitalisation records existed.The investigator’s conduct raised serious ethical concerns.It concluded that the findings of the state commission on pre-existing disease were “perverse and based on no evidence.”Also Read | ‘Can’t cite lack of qualification after 30 years’: Karnataka High Court orders regularisation for 52-year-old sweeperBurden of proof lies on insurerReaffirming settled law, the NCDRC held that the burden to prove suppression of material facts lies on the insurer.Rejection cannot rest on suspicion or unreliable documents.The commission relied on Supreme Court precedents to underline that insurers must meet strict evidentiary standards before denying claims.Income ground falls flatThe insurer’s second argument that the deceased had overstated his income was also rejected.The commission noted that monthly premiums of Rs 1,460.85 were regularly paid.The insured belonged to a business family.There was no evidence of financial incapacity.Calling the state commission’s reasoning an ipse dixit (unsupported assertion), the national consumer commission held that suspicion alone cannot invalidate a policy.Also Read | ‘Pension not bounty’: Calling out 30-year delay, Chhattisgarh High Court orders state to pay 9% interest to retiree’s widow, sonDoctor’s testimony exposes fabricationAt the centre of the case was a medical certificate dated February 17, 2010, which the insurer relied upon to allege that the deceased, Saurabh Selarka, suffered from hypertension and vertigo before taking the policy.However, under oath, the issuing doctor dismantled the insurer’s case.He never treated or examined the deceased.No diagnostic tests, prescriptions, or records existed.The certificate was issued to a person impersonating the deceased.He later admitted the certificate had “no legal value” and was false.The commission noted that these admissions “belie the certificate itself” and conclusively establish that it was procured by the insurer’s investigator.The admission that the certificate was obtained through impersonation was described as the “last nail in the coffin” of the insurer’s case.Strong words against insurance practicesIn unusually strong language, the commission condemned the insurer’s conduct.The claim was rejected “on a fake and procured evidence, not only uncreditworthy but also unethical.”It also rejected the insurer’s argument that such disputed facts could not be examined in consumer proceedings, noting that consumer forums have inquisitorial powers and can assess evidence, including affidavits and witness testimony.Relief granted: Full sum with interestAllowing the appeal, the NCDRC ordered payment of Rs 48.92 lakh (full sum assured) with 6 per cent interest from March 4, 2010 (date of repudiation).This payment has to be done within two months with 9 per cent interest in case of delay.The amount is to be deposited with the state commission for disbursal to the claimants.Vineet Upadhyay is an Assistant Editor with The Indian Express, where he leads specialized coverage of the Indian judicial system. Expertise Specialized Legal Authority: Vineet has spent the better part of his career analyzing the intricacies of the law. His expertise lies in "demystifying" judgments from the Supreme Court of India, various High Courts, and District Courts. His reporting covers a vast spectrum of legal issues, including: Constitutional & Civil Rights: Reporting on landmark rulings regarding privacy, equality, and state accountability. Criminal Justice & Enforcement: Detailed coverage of high-profile cases involving the Enforcement Directorate (ED), NIA, and POCSO matters. Consumer Rights & Environmental Law: Authoritative pieces on medical negligence compensation, environmental protection (such as the "living person" status of rivers), and labor rights. Over a Decade of Professional Experience: Prior to joining The Indian Express, he served as a Principal Correspondent/Legal Reporter for The Times of India and held significant roles at The New Indian Express. His tenure has seen him report from critical legal hubs, including Delhi and Uttarakhand. ... Read More © IE Online Media Services Pvt Ltd