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NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION, NEW DELHI
C. Viswanath, Presiding Member
Authorized Signatory, Bajaj Allianz Life Insurance Co. Ltd. and Ors. – Petitioners
versus
Kanduru Gangadhara Rao – Respondent
Revision Petition No.1054 of 2020
(Against the Order dated 08/09/2020 in Appeal No.422/2017 of the State Commission Andhra Pradesh)
Decided on 7.10.2021
Consumer Protection Act, 1986 – Sections 2(1)(g) and 21 : Consumer Protection Act, 2019 – Sections 2(11) and 58 – Life Insurance – Claim – Plea of suppression of material fact – Scope – Wife of the complainant took a dream plan policy – She died during subsistence of policy – Claim was repudiated on ground that the life assured suppressed her health condition of her taking treatment for “chronic non-specific cervictis” prior to obtaining the policy – However petitioner failed to satisfy that there was any coordination between the death of life assured and suppression of ailment “chronic non-specific cervictis” – Now not justified for National Commission to re-assess or re-valuate the evidence – Fora below rightly directed the insurer to pay claim amount to complainant with interest @ 9% p.a. – Interference with declined – Directions issued.
Held: Heard Learned Counsel for the Petitioners and carefully perused the record. Learned Counsel for the Petitioners submitted that the State Commission while passing the impugned order had ignored the basic principle of Insurance Law with respect of suppression of material fact while applying for the Policy of Insurance. State Commission failed to appreciate the evidence placed on record. It was also submitted that on 12.12.2011, the Life Assured submitted the proposal form to the Petitioners for the purpose of obtaining Life Insurance coverage named ‘Bajaj Allianz Super Cash Gain’. He further submitted that the Life Assured was hospitalized/under treatment during 01.04.2009 to 11.04.2009 for Dysfunctional Uterine Bleeding with Chronic non-specific cervicitis as per the medical reports and the same was not disclosed in the proposal form dated 12.12.2011 submitted by the Life Assured.
From the record it is seen that Petitioners in support of their contention, placed reliance on the treatment record, which was a mere photocopy and not certified. The Doctor who treated the Life Assured was also not examined nor was his affidavit filed by the Petitioners. Also, Petitioner failed to satisfy this Commission that there was any co-relation between death of the Life Assured and the suppression of ailment “Chronic non-specific cervicitis”. At this stage, it would not be just and fair to reassess or re-evaluate the evidence.
Jurisdiction of this Commission under Section 21 (b) is very limited. This Commission is not required to re-appreciate and reassess the evidences and reach to its own conclusion. The Court can intervene only when the Petitioner succeeds in showing that the Fora below have wrongly exercised its jurisdiction or there is a miscarriage of justice. It was so held by the Hon’ble Supreme Court in the case of Mrs. Rubi (Chandra) Dutta Vs. M/s United India Insurance Co. Ltd., (2011) 11 SCC 269.
Same principle has been reiterated by Hon’ble Supreme Court in the case of Lourdes Society Snehanjali Girls Hostel and Ors. Vs. H & R Johnson (India) Ltd. and Ors., (2016) 8 SCC 286.
I find no reason to interfere with the concurrent findings of both the Fora below. Petitioners have failed to point any illegality or irregularity in the impugned order passed by the State Commission, warranting interference in exercise of Revision Jurisdiction of this Commission. Revision Petition is accordingly dismissed. (Paras 7 to 11)
ORDER
C. Viswanath, Presiding Member.—The present Revision Petition has been filed by the Petitioners against order dated 08.09.2020 passed by the State Consumer Disputes Redressal Commission, Andhra Pradesh, Vijayawada (for short “State Commission”) in First Appeal No.422 of 2017.
2. Case of the Complainant/Respondent is that his wife had obtained Dream Plan Policy No.0241797636 for a sum of Rs.1,67,562/- for period from 15.11.2011 to 15.12.2025, by paying an annual premium of Rs.13,249.59. Complainant’s wife died on 21.10.2013. Complainant being the nominee informed the Opposite Party about the death of the life assured and filed a claim with Opposite Party No.1. The claim was repudiated, vide letter dated 16.12.2013 on the ground, that in the investigation it was found that the life assured suppressed her health condition of her taking treatment for “Chronic non-specific cervicitis” prior to obtaining the Policy. Complainant filed Consumer Complaint No.66 of 2017 before the District Forum with the following prayer:-
a) Direct the Opposite Parties to pay the claim amount of Rs.1,67,562/-, (Rupees One lakh sixty-seven thousand five hundred and sixty-two only);
b) To direct the Opposite Parties to pay a sum of Rs.30,000 /- (Rupees Thirty thousand only) as deficiency of service;
c) Subsequent interest@ 24% p.a. on Rs.1,67,562 /- from 21.01.2012 to till realization;
d) Costs of the Petition;
e) For any other relief or relives as the Forum may deem fit and proper in the above circumstances
3. The Complaint was contested by the Opposite Parties stating that wife of the Complainant deliberately and with malafide intention suppressed the material fact of pre-existing disease since 2009 which was material information for assessment of risk. It was submitted that the contract of Insurance is a contract of “uberrima fides” and the Opposite Party issued the said Policy in good faith. It was further contested that in view of the regulatory provisions and suppression of material information by the Life Assured, the Opposite Parties rightfully repudiated the claim of the Complainant, vide letter dated 16.12.2013.
4. District Forum after hearing Learned Counsel for the Parties and perusing the record held that it was duty of the Insurance Company to examine the concerned doctor who treated the Policy Holder for the alleged ailment, but no such steps were taken by the Opposite Party. It was further held that mere filing of some hospital records was not sufficient to show that the Policy holder was suffering from the ailment at the time of filing the proposal form. In absence of specific and cogent evidence, District Forum was unable to hold that the Policy holder/Deceased/Insured suffered from any ailment and suppressed this fact at the time of filing the Proposal form. District Forum allowed the Complaint as follows: -
“In the result, the complaint is allowed in part, directing the Opposite Parties 1 to 3 to pay claim amount of Rs.1,67,562/- (Rupees One lakh, Sixty-seven thousand, five hundred and sixty-two only) with interest @ 9% p.a. from 16.12.2013 till the date of actual realization, a compensation o Rs.10,000 - Rupees ten thousand only) and costs of Rs.2,500/- (Rupees Two thousand and five hundred only) to the Complainant. Time for compliance, one month from the date of receipt of this order.”
5. Aggrieved by the order of the District Forum, the Opposite Party filed First Appeal No.422 of 2017 before the State Commission. The State Commission after hearing the Learned Counsel for the Parties and perusing the record observed that burden of proof lies on the Opposite Parties to establish, by producing cogent and convincing material that the Life Assured suppressed material information in the proposal form. The Opposite Party did not place on record any material to substantiate its contention that the deceased Policy holder had supressed the material fact of her pre-existing ailment. The Opposite Parties did not produce the origin
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