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NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION, NEW DELHI
Sudip Ahluwalia, Presiding Member
Bajaj Allianz Life Insurance
Co. Ltd. and Anr. – Petitioners
versus
Macherla Kishore Kumar and Anr. – Respondents
Revision Petition Nos.776 and 777 of 2020
Decided on 17.8.2023
Counsel for the Parties:
For the Petitioners:Ms. Shweta Sigh Parihar, Advocate
For the Respondents:Mr. Y. Rajagopala Rao, Advocate
IMPORTANT POINT
Consumer Forum cannot reach to any conclusion without deciding conflicting versions of facts.
Headnote:
Consumer Protection Act, 1986 – Section 21[Consumer Protection Act, 2019 – Section 58] – Insurance – Repudiation of death claim on the ground of concealment of pre-existing ailment – Leaving the matter mid-way when real question to be determined in the case was whether or not there had been wilful suppression of facts, or any misleading information being supplied by deceased/life assured, by simply noting that witness had failed to turn up inspite of issuance of Summons, and without even seeking to verify whether Insurance Company was in any manner responsible for such non-appearance, would defeat very purpose of entire proceedings, in which endeavour ought to have been to get to bottom of truth in face of conflicting versions of facts – Impugned Orders which essentially have effect of artificially curtailing an opportunity to Petitioners/Opposite Parties to prove their case in accordance with law, without providing them fullest opportunity of enforcing attendance of concerned witness are unsustainable and against principles of natural justice – Impugned Orders set aside and Complaints remanded back to District Forum. (Paras 9, 10, 11 and 12)
Result: Revision Petitions allowed.
ORDER
Sudip Ahluwalia, Presiding Member—These are two Revision Petitions filed by the Insurance Company which was the Opposite Party in Consumer Complaint Nos.73 & 74 of 2013. The Complainants therein were the wife and brother of deceased Macherla Kishore Kumar who had taken two separate Insurance Policies on his life for Rs.2 lakhs and Rs.5 lakhs in favour of his wife and brother respectively.
2. One of the complaints was initially allowed by the District Forum, but the other one was dismissed in view of the contest raised on behalf of the Opposite Party. The Opposite Party/ Petitioner had contended that the Policy in question had been repudiated since the deceased had suppressed correct information regarding his state of health at the time of obtaining the Policies. According to the Insurance Company, the deceased was suffering from ‘Jaundice from fever’ and had been afflicted with “Conus Epndynoma with bladder involvement” and “Spiral Inliamedular Tumor with T11, T12”, for which he had undergone “Laminectomy & Excision of Intracimecluttany Epndymoma”, about a year or so earlier. Since those two decisions in the two separate complaints were passed by different Benches/Members of the District Forum, when the same were challenged in Appeal, the Ld. State Commission remanded both the matters with a direction that the same be heard and re-decided together. Thereafter, the District Forum on 20.04.2017 allowed both the complaints. It is noteworthy that the full quorum constituting the District Forum at that time had the same President and the two other Members. The orders were however, authored separately by Shri K. Sivarama Krishna, and by Smt. D. Raja Kumari, Lady Member in the District Forum. But as in both cases the complaints were allowed, the Appeals were preferred against the orders by the Insurance Company being FA/215/2020 and FA/250/2020, both of which were dismissed by the State Commission by virtue of the impugned Order which was passed by the President of the State Commission.
3. In doing so, the State Commission essentially was not convinced with the defense of the Insurance Company, and was of the opinion that the documentary material placed on record by the Insurance Company was insufficient, as well as inadmissible for the purpose of being relied upon, to defeat the case of the complainants.
4. Apart from minor variations, the reasoning recorded by the State Commission in both cases was virtually identical. The relevant extract thereof are set out below:—
(14) “On 31.12.2012, the complainant submitted a letter, Ex.A-5, to the Review Committee to reconsider her claim. Ex.A-6 is the acknowledgement. Ex.A-7 is the representation submitted to the Review Committee.
(15) The crucial question that falls for consideration is whether the opposite parties are justified in repudiating the claim of the complainant. The opposite parties repudiated the claim vide its letter, Ex.A-4, the relevant portion reads as under:—
“Non disclosure of pre proposal treatment for conus epndynoma with bladder involvement with an advice for surgical excision and diagnosis of Spiral inliamedular tumor with T11, T12 laminectomy and excision of intramedullary epndynoma.
Had these facts been disclosed the company would not have covered the risk for the above said policy under the same terms and conditions.
Hence, the claim has been repudiated due to misrepresentation of material facts”.
A perusal of Ex.A-4 gives an impression to any person that the life assured induced the opposite parties to issue Ex.A-1, policy by suppressing the material information with regard to his health condition. It is needless to say that the burden of proof lies on the Insurance Company to establish that the life assured suppressed the pre-existing disease in the proposal form with an ulterior motive. We have carefully scanned Ex.B-1, investigator report which is the basis for repudiation of the claim. There is no mention in Ex.B-1, investigator’s report, from
