ICICI Prudential stressed that the insurance holder’s death occurred barely over a month after issuance of the policy, which prompted a detailed investigation. (AI-generated image)Can a spelling difference change the fate of a Rs 50 lakh insurance claim? The Uttarakhand State Consumer Commission said it can’t, while ruling that “Shakil Ahmad” and “Shakeel Ahmad” were the same person and noting that the deceased policyholder had suppressed his history of coronary artery disease before taking life insurance.A bench of Kumkum Rani (president) and C M Singh (member) was hearing an appeal filed against a district consumer court’s September 22 order directing the insurer to pay Rs 50 lakh compensation to Sitara Begum, the wife of the deceased policyholder Shakeel Ahmad.“The possibility of two different persons having the same date of birth, date of death, obtaining insurance policy from the same insurance company and having the same family doctor is highly improbable and cannot ordinarily be accepted,” the consumer commission said on May 22, while overturning the earlier compensation order. ICICI Prudential argued that the insurance contract was based on the principle of ‘utmost good faith’ and required complete disclosure of medical history by the policyholder. (AI-generated image)Battle over one letter in a nameA major turning point in the case revolved around two contradictory medical certificates issued by the same doctor.One certificate dated March 14, 2020, allegedly stated that “Shakil Ahmad” had been suffering from coronary artery disease (CAD) and was under treatment since May 16, 2017. But another certificate dated November 13, 2020, claimed that “Shakeel Ahmad” had never suffered from any major illness, including CAD.The complainant argued that the two certificates related to different individuals because the names were spelled differently.But the state commission was unconvinced.It pointed out that both records carried the same date of birth, June 2, 1977, and the same date of death, October 29, 2019.It also noted similarities in address details, insurance policy references and even the family doctor’s records.The commission concluded that the spelling variation between “Shakil” and “Shakeel” was merely clerical and did not indicate two separate persons.ICYMI | No ‘Covid’ shield for Omaxe: Why consumer body ordered builder to pay 9% interest, Rs 1 lakh for 7-year delayCourt questions doctor’s explanationDuring the proceedings, Dr Vishal Hussain reportedly stated that the two certificates referred to different individuals. However, the state commission said the doctor failed to produce any documentary proof, identity records or supporting evidence to establish that claim.The bench further noted that the doctor himself had earlier mentioned the name “Shakil Ahmad” in a family doctor certificate linked with the insurance claim documents submitted by the complainant.“These circumstances clearly indicate that the names of Shakil Ahmad and Shakeel Ahmad were being used interchangeably in the documents pertaining to the same insured person,” the commission observed.Widow initially won Rs 50 lakh payoutThe dispute traces back to a life insurance policy purchased by Shakeel Ahmad from ICICI Prudential for a sum assured of Rs 50 lakh after paying a premium of Rs 7,357.His wife, Sitara Begum, was named as the nominee under the policy.The policy came into effect on September 21, 2019. But tragedy struck just weeks later when Shakeel Ahmad died on October 29, 2019, only one month and seven days after purchasing the insurance cover.Following his death, Begum submitted a claim seeking the insured amount.However, the insurance company rejected the claim on March 31, 2020, alleging that the deceased had hidden a serious pre-existing heart condition, CAD, while filling out the proposal form.The insurer refunded the premium amount instead.Claiming that the rejection was illegal and arbitrary, Begum approached the district consumer commission in Uddhamsingh Nagar.In September 2022, the district commission ruled in her favour and directed ICICI Prudential to pay Rs 50 lakh along with 6 per cent annual interest from September 1, 2020, besides litigation costs of Rs 5,000.Also Read | Why court reminded lawyer about ‘noble’ profession after he ‘lied’ about voting leave to skip SEBI trialInsurance firm flagged ‘concealment’ of illnessICICI Prudential challenged that order before the state commission, arguing that the insurance contract was based on the principle of “utmost good faith” and required complete disclosure of medical history by the policyholder.The insurer said the deceased had been suffering from CAD since 2017 and was undergoing treatment under Dr Vishal Hussain before purchasing the policy.According to the company, these facts were deliberately concealed at the time of taking the insurance cover.The company also stressed that the death occurred barely over a month after issuance of the policy, which prompted a detailed investigation.State panel reverses orderAfter reviewing the evidence, the state commission held that the district commission had failed to properly appreciate the documentary material and surrounding circumstances. The bench said the available records supported the insurer’s allegation that the policyholder had suppressed material facts regarding his medical condition while purchasing the policy.Story continues below this adAlso Read | ‘Sakali Devi is alive’: Cop wrongly reports Bihar woman dead, gets Patna High Court pardon after apologyThe commission also referred to Section 45 of the Insurance Act, 1938, which permits insurers to repudiate claims in cases involving suppression or misrepresentation of material facts within the prescribed period.Allowing the insurer’s appeal, the state commission set aside the September 28, 2022, order of the district consumer commission and dismissed Sitara Begum’s complaint.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