IMPORTANT POINT
Revisionary jurisdiction is limited in case of concurrent orders of lower Fora.

ORDER

Anup K. Thakur, Presiding Member—This Revision Petition No.1002 of 2018 challenges the impugned order of the Maharashtra State Consumer Disputes Redressal Commission, Nagpur (‘State Commission’, hereafter) dated 13.09.2017 in F.A. No. A/15/204. Vide this order, the State Commission had dismissed the appeal against the order of the District Consumer Disputes Redressal Forum, Gondia (‘District Forum’, hereafter) dated 22.10.2014 in C.C. No.06/2013.

2. Brief facts are that the respondent/complainant-Narendra Pundlik Ramteke (‘complainant’, hereafter) had purchased policy bearing no.002684889, for the period 13.05.2009 to 13.05.2012 by paying premium of Rs.13,198/-. The complainant became ill on 22.11.2009 and was admitted in the hospital of Dr. Bahekar of Gondia. Thereafter, he was shifted to Central India Institute of Medical Sciences (CIIMS) on 22.11.2009 where he remained under treatment from 22.11.2009 to 16.02.2010, then from 17.02.2010 to 13.03.2010 and lastly from 04.06.2010 to 06.06.2010. In this period, he underwent operation and incurred a total expenditure of Rs.8 to 9 lakh. When he submitted his claim for reimbursement to the petitioner/OP-Birla Sun Life Insurance Co. Ltd. (OP hereafter), the same was repudiated vide letter dated 7.6.2011 on the ground that he had withheld vital medical information at the time of making his insurance proposal. Disputing this, the complainant filed a consumer complaint before the District Forum. This was contested by the OP by filing a written statement. The main ground taken was that the complainant had not approached the consumer forum with clean hands. The complainant was alleged to have suppressed material facts, thus misrepresenting his case while filling up the proposal form for obtaining insurance. It was submitted that the application form pertaining to medical history and personal details of the principal insured had answered the following question in the negative:

(i) “within the past five years have you consulted doctor or other health practitioner except for common cold, influenza lasting less than four days;

(ii) “have you ever had or sought advice any of the following: anemia, leading or blood disorders?”

It is alleged that the complainant had filled up this form after fully understand the terms and conditions of the policy. During the course of investigation by the OP it was established that the complainant was suffering from Sickle Cell Disease (SCD), a fact which was withheld from the OP. It was argued in the written reply that this material non-disclosure would have influenced the decision of the OP qua acceptance or rejection of the contract of insurance. As such, there was no deficiency of service in the OP rejecting the claim lawfully.

3. The District Forum held that from the documentary evidence on record, it was proved that the complainant was healthy before the operation for which insurance claim had been filed. The District Forum noted that the bills from the medical store and CIIMS Hospital, Nagpur was Rs. 8,38,720/-. It further noted that OP, while rejecting the claim, had not been able to prove their reason for rejection with independent and reliable evidence. Therefore, the District Forum allowed the complaint, directing the OP to give Rs.8 Lakh with 9% interest from 16.1.2013 till realization, along with Rs.10,000/- as compensation for mental suffering and Rs. 5,000/- as costs. This order was challenged by the OP before the State Commission in F.A. No. A/15/204 which failed. Hence, this revision petition.

4. Heard arguments of the learned counsels for the parties on 14.10.2019.

5. Learned counsel for the petitioner, after submitting the facts briefly, argued that the crux of this case was whether the complainant’s non-disclosure of the pre-existing disease of SCD while making the proposal for insurance, amounted to a material non-disclosure which vitiated the contract of insurance. He argued that when the claim was filed on 21.05.2010, the OP had got t