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Judgment
Dr. Inder Jit Singh, Presiding Member
The present Revision Petition (RP) has been filed by the Petitioner against Respondent as detailed above, under section 21 (b) of Consumer Protection Act 1986, against the order dated 20.07.2018 of the State Consumer Disputes Redressal Commission Rajasthan (hereinafter referred to as the ‘State Commission’), in First Appeal (FA) No. 74 of 2018 in which order dated 30.10.2017 of Ajmer District Consumer Disputes Redressal Forum (hereinafter referred to as District Forum) in Consumer Complaint (CC) no.129 of 2014 was challenged, inter alia praying for setting aside the order dated 20.07.2018 of the State Commission.
While the Revision Petitioner (hereinafter also referred to as OP) was Appellant and the Respondent (hereinafter also referred to as Complainant) was Respondent in the said FA No. 74 o 2018 before the State Commission, the Revision Petitioner was OP and Respondent was Complainant before the District Commission in the CC no. 129 of 2014.
Notice was issued to the Respondent on 27.09.2018 Parties filed Written Arguments/Synopsis on 22.02.2019 and 20.02.2019 respectively.
Brief facts of the case, as emerged from the RP, Order of the State Commission, Order of the District Forum and other case records are that OP No.2 contacted complainant and offered Life Insurance Policy for his son, Deepak Kumar from OP No.1. On completing all the necessary formalities, the Insurance Officer of OP No.1 insured the complainant’s son for life on 15.02.2011 for a sum of Rs.8,45,000/- and collected premium of the insurance amount to Rs.49,975/- and thereafter policy was issued. Second premium was also paid. The son of the complainant met an untimely natural death on 12.12.2012. Claim form was submitted by complainant to the OP. However, the claim was rejected by the OP vide letter dated 15.03.2013. Surplus amount collected towards premium of the complainant’s son was returned by OP No.1 . Legal notice was sent by complainant but no reply was received. Being aggrieved, the complainant filed CC before the District Forum and District Forum vide order dated 30.10.2017 allowed the complaint. Being aggrieved, the OPs filed an Appeal before the State Commission and State Commission vide order dated 20.07.2018 dismissed the appeal. Therefore, OP is before this Commission now in the present RP.
Petitioner(s) have challenged the said Order dated 20.07.2018 of the State Commission mainly on the ground that there is suppression of material information regarding the health of the life assured and that complainant’s son was suffering from pre existing illness prior to the policy and at the time of filing the proposal form. Contract of insurance is based on the foundation of utmost good faith and if life assured had disclosed his past medical history, the subject policy would not have been issued by the Petitioner at all. The Petitioner has acted strictly as per the terms and conditions of the policy and have repudiated the claim on just grounds.
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.
6.1 Counsel for the Petitioner apart from repeating the points which are stated in para 5, also argued that complainant informed the Petitioner of the unfortunate death of his son wherein cause of death was stated as pneumonia. Thereafter, Petitioner conducted statutory investigation under clause 8 (3) of the Insurance Regulatory and Development Authority in order to verify the authenticity of claim. However, from the investigation report dated 21.01.2013, it was revealed that deceased was suffering from ARTS syndrome and was suffering from MR (mild), CP-Spastic Paraparesis 20-25% disability as per the prescription of the treating pediatric doctor from Sri Balaji Hospital. Further, insured had history for frequent respiratory tract infections that included cough, fever and difficulty in breathing and that insured was suffering from these ailments much prior to the signing of the proposal form. It is argued that on ground of suppression of material facts, the claim was repudiated. Reliance is placed on the following judgments of the Hon’ble Supreme Court :
a. P.C.Chacko and Anr. Vs. Chairman, Life Insurance Corporation of India & Ors. AIR 2008 SC 424.
b. Satwant Kuar Sandhu Vs. New India Assurance Co. Ltd. ( 2009) 8 SCC 316
c. United India Insurance Co. Ltd. Vs. Harchand Rai Chandan Lal [1 ( 2003) CPJ 393]
d. Vikram Greentech ( I) Ltd. and Anr. Vs. New India Assurance Co. Ltd. II ( 2009) CPJ 34
e. Reliance Life Insurance Company Ltd. Vs. Rekhaben Nareshbhai Rathod ( 2019) 6 SCC 175
f. Life Insurance Corporation of India Vs. Manish Gupta ( 2019) 11 SCC 371
g. Branch Manager, Bajaj Allianz Life Insurance Co. Ltd. and Ors. Vs. Dalbir Kaur ( 2021) 13 SCC 553.
6.2. Counsel for the respondent argued that order given by the Fora below is passed after verification of all the facts and evidences regarding the case and policy was given by the petitioner after verifying all the facts regarding the health of the deceased person. The deceased was not suffering from any pre existing disease. Counsel further argued that petitioner did not file any evidence or any medical receipt regarding the pre existing disease. Counsel has relied on the order of the National Commission passed in Neelam Chopra Vs. Life Insurance Corportion Ltd. in which this Commission has observed that insurance claim cannot be denied on the grounds of life style diseases that are so common.
The claim of Complainant was repudiated vide letter dated 15.03.2013 by the OP Insurance Coompany on the ground of suppression of material facts of pre-existing ailments at the time of taking the policy. District Forum in its order has stated that ‘no cogent evidence has been adduced in support of grounds on which the claim of the insured has been dismissed by the insurance company nor any certificate / evidence pertaining to this case has been filed. No only this, as to who investigated the case after receipt of claim and what documents were collected in support of the diseases alleged, have not been filed. It is thus evident that grounds on which claim has been rejected are unsubstantiated. Resultantly, it is held that respondent Insurance Company has failed to prove that insured was suffering from any of the alleged diseases or that he concealed material facts of his disease in the proposal form filled up before taking up the policy’. The State Commission in appeal by the opposite party Insurance Company upheld the order of the District Forum and dismissed the appeal, observing that son of complainant died because of pneumonia; he was not suffering from any disease; he died a natural death; District Forum has not committed any error in allowing the complaint of the complainant. The only documents on record are the prescription dated 11.12.2012 of Shree Balaji Hospital, which states that patient was suffering from ART and an undated certificate from Shree Balaji Hospital signed by Dr. Banwari Lal Sharma.
The proposal form was filled on 15.02.2011. The Opposite Party Insurance Company has not placed on record any documents or treatment record of the insured prior to this date which will show that he was suffering from various diseases alleged to have been concealed while filling the proposal form. In the repudiation letter dated 15.03.2013, it is stated that “as per prescription slip of Shree Balaji Hospital, Late Mr. Jethaliya was treated for some infection on 05.10.2005, 18.03.2006, 02.12.2006, 19.01.2010, 26.01.2010, 11.12.2012 and 07.08.2012”. However, no copies of any of these prescription slips have been produced, except prescription slip dated 11.12.2012, which is after the date of filling the proposal form and this slip makes no reference to earlier dates from 05.10.2005 to 26.01.2010 stated above. Although there is a reference to OPD slip dated 05.10.2005 in the undated certificate of Shree Balaji Hospital, copy of this OPD slip is not on record.
In this case, there are concurrent findings of both the Fora below. As was held by the Hon’ble Supreme Court in Rubi Chandra Dutta Vs. United India Insurance Co. Ltd. [(2011) 11 SCC 269] that the scope in a Revision Petition is limited. Such powers can be exercised only if there is some prima facie jurisdictional error appearing in the impugned order. In Sunil Kumar Maity Vs. State Bank of India & Ors. [AIR (2022) SC 577] held that “the revisional jurisdiction of the National Commission under Section 21(b) of the said Act is extremely limited. It should be exercised only in case as contemplated within the parameters specified in the said provision, namely when it appears to the National Commission that the State Commission had exercised a jurisdiction not vested in it by law, or had failed to exercise jurisdiction so vested, or had acted in the exercise of its jurisdiction illegally or with material irregularity.”
The Hon’ble Supreme Court in Rajiv Shukla vs Gold Rush Sales And Services Ltd. Civil Appeal No. 5928 of 2022, decided on 8th September, 2022, held that:-
“13. As per Section 21(b) the National Commission shall have jurisdiction to call for the records and pass appropriate orders in any consumer dispute which is pending before or has been decided by any State Commission where it appears to the National Commission that such State Commission has exercised its jurisdiction not vested in it by law, or has failed to exercise a jurisdiction so vested, or has acted in the exercise of its jurisdiction illegally or with material irregularity. Thus, the powers of the National Commission are very limited. Only in a case where it is found that the State Commission has exercised its jurisdiction not vested in it by law, or has failed to exercise the jurisdiction so vested illegally or with material irregularity, the National Commission would be justified in exercising the revisional jurisdiction.
In exercising of revisional jurisdiction the National Commission has no jurisdiction to interfere with the concurrent findings recorded by the District Forum and the State Commission which are on appreciation of evidence on record. Therefore, while passing the impugned judgment and order the National Commission has acted beyond the scope and ambit of the revisional jurisdiction conferred under Section 21(b) of the Consumer Protection Act.”
In view of foregoing, we find no illegality or material irregularity or jurisdictional error in the order of the State Commission, hence the same is upheld. Accordingly, the Revision Petition is dismissed.
The pending IAs in the case, if any, also stand disposed off.