KAVITHA vs Reliance Life Insurance Co. Ltd.

THIS revision petition has been filed by the petitioner against the order dated 14.12.2011 passed by Karnataka State Consumer Disputes Redressal Commission, Bangalore (in short, ''the State Commission '') in Appeal No. 4584/2010 - M/s. Reliance Life Insurance Co. Ltd. and Ors. Vs. Smt. Kavitha by which, while allowing appeal, order of District Forum allowing complaint was set aside and complaint was dismissed.

BRIEF facts of the case are that complainant/Petitioner ''s husband deceased Mallikarjun Kante got his life assured for a sum of Rs.1,00,000/ - from OP/respondent and policy commenced from 21.10.2008. Mallikarjun Kante died on 25.12.2008. Complainant/petitioner submitted claim before OP. OP vide letter dated 14.2.2009 sent cheque for a sum of Rs.579.20 and repudiated claim on the ground of suppression of material fact. Alleging deficiency on the part of OP, complainant filed complaint before District Forum. OP resisted complaint and submitted that deceased Mallikarjun Kante was diagnosed by ''Cirrhosis of liver '', but suppressed this fact in his proposal form. Deceased was advised for admission in Prayavi Hospital, but he refused; so, claim was rightly repudiated and as there was no deficiency in service and prayed for dismissal of complaint. Learned District Forum after hearing both the parties allowed complaint and directed OP to pay assured amount of Rs.1,00,000/ - along with Rs.5,000/ - as cost. Appeal filed by OP was allowed by learned State Commission vide impugned order against which, this revision petition has been filed. Heard learned Counsel for the parties and perused record.

LEARNED Counsel for the petitioner submitted that petitioner never went to Prayavi Hospital for checkup and requested District Forum to summon original record as photocopies pertaining to hospital record were forged one and learned District Forum rightly allowed complaint; even then, learned State Commission committed error in allowing appeal and dismissing complaint; hence, revision petition be allowed and impugned order be set aside. On the other hand, learned Counsel for the respondent submitted that order passed by learned State Commission is in accordance with law; hence, revision petition be dismissed.

IT is not disputed that complainant ''s husband obtained insurance policy from OP and within 65 days insured died. The core question to be decided in this revision petition is whether insured suppressed material fact regarding his health condition in the proposal form. Op has placed reliance on the Prayavi Hospital outpatient record dated 12.6.2008, whereas learned Counsel for the complainant has disputed this record and submitted that this is a forged document and also moved application on 11.8.2010 for calling original record from the Prayavi Hospital. Learned District forum has not decided this application and did not call for original record, but allowed complaint and observed as under: ''''Herein the instant case there is no convincing evidence to show that the deceased 6 months prior to the date of submitting proposal either he has admitted in the hospital or operated for any serious ailment. The respondents in the instant case repudiated the claim solely on the basis of outpatient slip. Absolutely, there is no evidence to show that deceased was found suffering any serious ailment or he was operated mere proximity of taking policy. It is highly impossible to accept the respondents contentions that the deceased was suffering from liver cirrhosis on the basis of outpatient slip that too in the absence of producing any diagnostic report particularly in respect of Liver cirrhosis ''''.

Thus, District Forum did not believe on photocopy of record of the Prayavi Hospital, but learned State Commission relied on Prayavi Hospital as outpatient record and held that material facts regarding health have been suppressed by the insured and on that basis complaint was dismissed.

AS there was dispute regarding genuineness of record of Prayavi Hospital and complainant had already moved application before District Forum for calling original record of Prayavi Hospital it would have been appropriate for District Forum to allow this application and call record and decide complaint, but learned District Forum holding that there was no convincing evidence to prove this outpatient slip allowed complaint. In such circumstances, it would be appropriate to set aside the impugned order as well as order of District Forum and remand the matter back to the District Forum to first decide the application of complainant filed for summoning original record and then decide the complaint after hearing both the parties.

CONSEQUENTLY , revision petition filed by the petitioner is allowed and impugned order dated 14.12.2011 passed by learned State Commission in Appeal No. 4584/2010 - M/s. Reliance Life Insurance Co. Ltd. & Ors. Vs. Smt. Kavitha and order of District Forum dated 20.09.2010 passed in Complaint No. 170/09 - Smt. Kavitha Vs. The Branch Manager, Reliance Life Insurance Co. Ltd. & Anr. is set aside and matter is remanded back to learned District Forum to decide the application dated 11.8.2010 filed by complainant and decide the complaint afresh after giving an opportunity of being heard to both the parties. Parties are directed to appear before District Forum on 25.3.2014.