Rati Ram Meena vs Tata Aig Life Insurance Co. Ltd

This revision petition has been filed by the petitioner Rati Ram Meena against the order dated 9.8.2017 of the State Consumer Disputes Redressal Commission, Rajasthan, (in short 'the State Commission') passed in First Appeal No.524 of 2017.

Brief facts relevant for disposal of the revision petition are that the mother of complainant/petitioner obtained insurance policy on 27.11.2008 for a sum of Rs.7,95,000/- for a period of 15 years ending on 27.11.2023. On 4.2.2010 during the tenure of the insurance policy the insured expired due to natural death. Petitioner being a nominee of the policy lodged a claim with the opposite party Company. On 9.9.2010, opposite party repudiated the claim of the complainant on the ground of suppression of material facts.

Aggrieved, the complainant preferred complaint being petition No.1701/12 before the District Consumer Disputes Redressal Forum-II, Jaipur (in short 'the District Forum'). Vide order dated 31.3.2017, the District Forum dismissed the complaint on the ground of suppression of material facts at the time of obtaining the policy.

Aggrieved by the order dated 31.03.2017, the complainant preferred an appeal being No.524 of 2017 before the State Commission. The State Commission vide its order dated 09.08.2017 dismissed the appeal.

Hence the present revision petition.

Learned counsel for the petitioner stated that the State Commission erred in not appreciating that in this case the deceased was an illiterate lady as she had put thumb impression on her proposal form and the proposal form was filled in by the agent Sandeep Dadhich and therefore, if anything was found wrong in the proposal form on the part of the deceased, for that, the insured could not be held responsible as the terms and conditions of the policy were not disclosed to the deceased and from that point of view also, the present case is not a case of suppression of material facts regarding health.

Learned counsel for the petitioner averred that the State Commission erred in not appreciating that the respondent has failed to prove the fact that deceased was suffering from CVA & IHD prior to commencement of insurance policy as respondent has not filed any certificate of treating doctor or affidavit of the investigator to prove that the medical record relied upon by the respondent is of deceased Smt. Bada Bai Meena.

Learned counsel for the petitioner further stated that the State Commission erred in not appreciating that from the record it is very much clear that after taking the policy and before her death, the deceased had never been admitted in any hospital, meaning thereby that the death of the insured was a sudden natural death and when the death of the deceased was a natural death, in such a case it could not be said that the deceased was aware that she would die in near future and from that point of view also it could not be said that the deceased had knowingly and fraudulently suppressed the material facts.

I have carefully considered the arguments of the learned counsel for the petitioner and have examined the record.

The State Commission has observed the following:-

"There is no dispute about the fact that policy was purchased by the insured and proposal form was filled on 27.11.2008 and questions as regard to health details were answered in negative but the respondent has submitted the admission discharge record of September 2008 of SMS Medical College wherein it has been specifically mentioned that insured is suffering from Cerebro Vascular Accident (CVA), Ischemic Heart Disease (IHD) and Hemiparesis and she was operated for fixing pacemaker. Hence, in view of the above the Forum below has rightly held that material facts have been suppressed."

Both the fora below have given concurrent finding of fact that the insured suppressed the material fact of her operation and treatment for Cerebro Vascular Accident (CVA) and Ischemic Heart Disease (IHD) and Hemiparesis prior to filling of the proposal form. In the matter of concurrent finding of fact, the scope under the revision petition is quite limited as held by the Hon'ble Supreme Court in Lourdes Society Snehanjali Girls Hostel and Ors. Vs. H&R Johnson (India) Ltd. and others, (2016) 8 Supreme Court Cases 286, as under:-

"23. The National Commission has to exercise the jurisdiction vested in it only if the State Commission or the District Forum has either failed to exercise their jurisdiction or exercised when the same was not vested in them or exceeded their jurisdiction by acting illegally or with material irregularity. In the instant case, the National Commission has certainly exceeded its jurisdiction by setting aside the concurrent finding of fact recorded in the order passed by the State Commission which is based upon valid and cogent reasons."

The learned counsel for the petitioner has doubted the medical record submitted by the respondent. Both the fora below have relied upon these papers and have given concurrent finding. Based on the above quoted judgment of Hon'ble Supreme Court in Lourdes Society Snehanjali Girls Hostel and Ors. Vs. H&R Johnson (India) Ltd. and others (supra), this finding of fact can also not be interfered with. If the medical papers are disputed, the onus was on the complainant to have filed certain other documents to prove that these medical papers did not relate to the mother of the complainant i.e. the insured. However, the complainant has failed in this regard.

So far as the argument of the learned counsel for the petitioner in respect of the insured being an illiterate lady and the form having been filled by the agent is concerned, the position in this regard is very clear that if the proposal form is signed by the proposer then all the entries will be deemed to have been written either by the proposer or with his or her consent and approval or on proposer's instructions. The agent can only facilitate the proposer in filling of the proposal form, however, the responsibility of filling up of the proposal form remains with the proposer. There is a clear verification Clause in the proposal form where the proposer has to verify all entries made in the proposal form. Thus, there is no merit in this argument of the learned counsel for the petitioner that as the proposal form has been filled by the agent and the insured was an illiterate lady, the discrepancies and wrong answers given in the proposal form should not be read against the insured and may be overlooked.

Based on the above discussion, I do not find any illegality, material irregularity or jurisdictional error in the order dated 09.08.2017 of the State Commission which calls for any interference from his Commission. Accordingly, the revision petition No.22 of 2018 is dismissed in limine.