Insurance Policy Exclusion | Onus To Prove Suicide Can Be Discharged By Circumstantial Evidence And Unexplained Discrepancies In Medical Records: NCDRC

"The insurer can discharge this onus by leading circumstantial evidence and presenting facts that are incompatible with any other reasonable hypothesis." National Consumer Disputes Redressal Commission (NCDRC) held that while the burden of proving suicide as an exclusion clause in an insurance contract lies on the insurer, this onus can be satisfied through a preponderance of probabilities based on circumstantial evidence, particularly when official medical records are found to be manipulated.

A bench comprising Dr. Inder Jit Singh (Presiding Member) and Mr. Shashi Nandkeolyar (Member) observed that "the cumulative weight of the circumstantial evidence, the contemporaneous medical records, and the unexplained discrepancies in the subsequently produced records, establish the case of suicide."

The complainant, Deepak Hada, sought insurance payouts for his late father, Madan Lal Hada, who died due to multi-organ failure after ingesting copper sulphate. The complainant alleged this was an accidental ingestion covered under three insurance policies, while the insurer, ICICI Lombard, repudiated the claims, citing the "suicide" exclusion clause and non-disclosure of pre-existing medical conditions. The insurer contended that the deceased intentionally consumed poison kept in a cough syrup bottle, a theory supported by initial medical records from the Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGI), Lucknow.

The commission was primarily tasked with determining whether the death constituted an "accident" or "suicide" under the policy terms and whether the insurer’s repudiation was valid. Additionally, the bench examined whether the bank involved, ICICI Bank, committed a deficiency in service by failing to lodge the insurance claims on behalf of the deceased.

Standard of Proof in Suicide Cases

The Commission reaffirmed the settled legal position that the burden of proving that a death falls within an exclusionary clause, such as suicide, lies strictly upon the insurer. However, the bench clarified that this does not require a standard of proof equivalent to a criminal conviction.

Weight of Contemporaneous Records

The bench emphasized the importance of contemporaneous medical records obtained directly from the hospital during the claim investigation. It observed that the original records provided by SGPGI consistently recorded the manner of death as "suicide." The complainant’s reliance on a subsequently produced document, which added an "accident" tick-mark, was viewed with severe skepticism.

"The subsequently produced records relied upon by the complainant disclose apparent inconsistency... The said material discrepancy has remained wholly unexplained. This unexplained variation raises serious doubts regarding the authenticity and reliability of the subsequently produced record."

Implausibility of Accidental Consumption

The court found the complainant’s narrative—that the deceased accidentally consumed copper sulphate meant for cleaning a swimming pool at a remote property—to be highly improbable. Evidence revealed that the family had not visited the property in over a year and the swimming pool was non-functional.

"Keeping a deadly poison in a cough syrup bottle by one's bedside for 'use in a filtration plant' at a farmhouse in Kolkata is a highly improbable and unnatural act. The family's explanation does not inspire confidence."

Absence of Deficiency by the Bank

Regarding the claim against ICICI Bank, the NCDRC held that the bank, as a policyholder, acted as a mere facilitator. The bank’s independent recovery proceedings under the SARFAESI Act were deemed legally permissible and did not constitute a deficiency in service. The insurer's repudiation was found to be based on the merits of the claim, independent of the bank's actions.

The NCDRC concluded that the insurer had successfully discharged its burden by demonstrating that the death was a suicide through circumstantial evidence, including the unexplained manipulation of hospital records and the implausible explanation of accidental ingestion. Consequently, the complaint was dismissed, and all prayers for the payment of the sum assured and damages were rejected.

Date of Decision: 10 September 2026