IMPORTANT POINT
Petitioners failed to point any illegality or irregularity in the order passed by the State Commission, warranting interference in exercise of revisional jurisdiction of this Commission.

ORDER

The Present Revision has been filed by the Petitioners against the impugned order dated 12.11.2019 passed by the State Consumer Disputes Redressal Commission, Andhra Pradesh, Vijayawada (hereinafter referred to as the “State Commission” ) in Appeal No. 502 of 2016.

2. Along with the Revision Petition, IA/4357/2021, an application for condonation of delay of 14 days has also been filed by the Petitioners. As per computation done by the Registry, there is a delay of 114 days. For the reasons stated in the application and in the interest of justice, IA/4357/2021 is allowed and delay condoned.

3. The case of the Complainant/Respondent was that his brother purchased Health Policy No.0244560624 valid from 28.12.2011 to 28.12.2016, for a assured of Rs.3,33,968/-. The Complainant/Respondent was nominee in the Policy. On 05.01.2013, the Life Assured died due to indigestion leading to motions and vomiting. The Complainant informed the Opposite Parties about the death of his brother, along with the death certificate and submitted the Insurance claim. The Opposite Parties appointed a Surveyor who recorded the statement of the Complainant and also collected the original Policy Bond and Death Certificate. On 29.04.2013 the Opposite Parties sent a letter to the Complainant intimating that the claim had been repudiated on the ground of suppression of material fact of pre-existing ailment. Aggrieved by Repudiation of the claim, Complainant filed Consumer Complaint No.228 of 2013 with the District Forum with the following prayer:-

“The Applicant therefore pray that the Honorable Forum may be pleased to pass orders in favour of the Applicant and against the opposite parties as:

a. To direct the opposite parties to pay policy amounts of Rs.3,33,968.00 (Three lakhs thirty three thousand nine hundred sixty eight only) along with benefits thereon.

b. Interest at 24% PA from the date of death of the deceased 5.1.2013.

c. To direct the opposite parties to pay Rs.30,000/- for the deficiency of service and also for causing mental agony, pain and suffering and

d. such other relief or reliefs as the Honorable Forum deems fit and proper in the circumstances of the case.

e. For the cost of the petition Rs.

5,000-.”

4. The Opposite Parties/Petitioners resisted the Complaint by filling Written Statement submitting that the Repudiation of the claim was justified, as the Life Assured had not disclosed the material fact regarding pre-existing ailment. The Life Assured was under an obligation to mention the same in the proposal form at the time of applying for the Insurance Policy.

5. The District Forum after hearing the Learned Counsel for the Parties and perusing the record, partly allowed the Complaint with the observation that the Opposite Parties failed justify the repudiation of claim by filing affidavit of the doctor who treated the Insured as well as the Investigator’s affidavit. The Investigator’s Report was also not duly stamped by the relevant authority. The District Forum further held that it was the duty of the Opposite Party to check the health condition of the Insured before issuing the Health Policy. The District Forum passed the following order: -

“In the result, the complaint is allowed in part, directing the OPs 1 and 2 to pay policy amount of Rs.3,33,968/- (Rupees three lakhs thirty-three thousand nine hundred and sixty-eight only) with 6% p.a., interest from the date of registration of complainant i.e., 20-09-2013 till the date of actual realization and costs of Rs.2,500/- (Rupees two thousand five hundred only) to the complainant. Time for compliance, one month from the date of this order.”

6. Aggrieved by the order of the District Forum, the Opposite Parties preferred Appeal No.502 of 2016 before the State Commission. The State Commission concurred with the finding of the District Forum that weightage cannot be given to the Investigator’s Report and other evidence which showed concealment of material facts, as they were not certifi