IMPORTANT POINT
Acceptance of order – Complainant certainly cannot challenge the correctness or otherwise of the Order of the Insurance Ombudsman at least in a Consumer Forum, since such Order was passed by a statutory Authority not subordinate to the Consumer Fora and having once accepted the same unconditionally, she cannot assail it on merits except before any Court possessed of Writ jurisdiction.

ORDER

Sudip Ahluwalia, Presiding Member—The present Revision Petition under Section 21(b) of Consumer Protection Act, 1986 (hereinafter referred to as “Act”) has been filed by Sugandha Singh (hereinafter referred to as “Petitioner/Complainant”) against the impugned Order dated 28.03.2018 passed by the State Consumer Disputes Redressal Commission, Uttar Pradesh (hereinafter referred to as “State Commission”) in First Appeal No. 3040 of 2016, vide which the Appeal filed by the Petitioner herein was dismissed.

2. Brief facts of the case as per the Complaint are that husband of the Petitioner, Sh. Rajeev Kumar, was working as Engineer with TV18 Broadcast Limited in Noida. Unfortunately, the husband of the Petitioner passed away on 21.04.2013 due to sudden heart attack. He had taken “Home Suraksha Plus Policy” bearing No. 00009307000100 for an amount of ?22,426/- on 12.10.2009 which was valid up to 11.10.2014 for a period of 5 years from HDFC Ergo GIC Ltd. (hereinafter referred to as “Respondent No. 1/Insurer”). There was no medical check-up required at the time of purchasing the Policy and this fact has also been mentioned in the Policy booklet. The HDFC Ltd. (hereinafter referred to as “Respondent No. 2”) had also provided a loan of ?11,00,000/- to husband of the Complainant by mortgaging of the said Policy of the husband of the Complainant vide loan account No. 588070078 in the month of November 2012. After taking the said loan, the husband of the Complainant regularly paid the monthly instalments of said loan by paying ?10,038/- per month to the Respondent No. 2, after a while the instalment amount was increased to ?11,346/-. The Complainant and her children are the legal beneficiaries of late Sh. Rajeev Kumar and entitled to claim under the said Policy. The Complainant then lodged her claim of ?11,35,892/- but the said claim was repudiated on the ground that the Complainant had not submitted the hospitalisation documents of her husband. The husband of the Complainant had died on the way to Hospital. The Complainant then submitted documents issued by Paras Hospital, 130, Sec-4, Vaishali, Ghaziabad, U.P. The Complainant sent a Legal Notice to the Respondent No. 1, 2 and Manager, HDFC Ltd (HUB)., Delhi (hereinafter referred to as “Respondent No. 3”) by Registered Post on 21.12.2013. On the said Notice, the Respondent No. 1 replied that the claim of the Complainant is not maintainable. The Complainant received two letters dated 19.09.2013 and 13.12.2014 from the Respondent No. 1 which stated that “since no diagnosis could be made by the Doctors, in absence of investigation report and also as post-mortem was not done, diagnosis MYOCARDIA INFRACTION cannot be ruled out, hence case is recommended for repudiation”. Aggrieved by the wrongful repudiation of the claim, the Petitioner filed a Complaint before District Consumer Disputes Redressal Commission, Ghaziabad.

3. The District Commission vide its Order dated 04.11.2016 dismissed the Complaint. The relevant extract of the Order of the District Commission are set out as below—

“The forum is of the view that the Ld. Ombudsman taking the sympathetic way has given justice to the Complainant despite the conditions of the insurance provided 75% of insured amount which has been received by the Complainant, on this basis the Complaint filed by the Complainant is dismissed in the interest of justice.

Order

The Complaint of the Complainant is dismissed both parties will bear their own costs.”

4. Aggrieved by the Order of the District Commission, the Petitioner filed its Appeal before the State Commission. The State Commission dismissed the Appeal vide the impugned Order dated 28.03.2018. The relevant extract of the Order of the State Commission are set out as below—

“On the basis of complete arguments I am of the opinion that it is not necessary to interfere in the Order passed by District Forum, therefore the appeal of the Appellant/Complainant is dismissed with the relief that as per l