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2023 Supreme(Online)(Del) 18309

NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION, NEW DELHI
Subhash Chandra, MEMBER
Bharti Axa Life Insurance Ltd. v. Amrik Kaur
Revision Petition No. 3295 of 2017| Appeal No. 341 of 2017| Consumer Complaint No. 320 of 2016



The concurrent findings of fact by lower fora are binding and cannot be interfered with unless proven perverse or lacking jurisdiction.

Headnote:The present revision petition under the Consumer Protection Act, 1986 challenges a dismissal of an appeal concerning a life insurance claim repudiation. The claim denial arose from the insured's failure to disclose prior hospitalization, deemed a material fact. The District Forum initially ruled in favor of the complainant, which the State Commission upheld. The court affirmed that the insurer's grounds for repudiation were justified, citing concurrent findings of fact that did not exhibit any irregularities or illegality. The ruling dismissed the petition founded on a lack of reconsideration of evidence established by the lower forums.

Result: Revision Petition dismissed.

Table of Content
1. the appeal revolves around the denial of an insurance claim due to alleged non-disclosure. (Para 1 , 2)
2. discussions on the evidence of material suppression by the insured. (Para 3 , 4)
3. findings on the validity of claim rejection based on material facts. (Para 5 , 6)
4. the jurisdiction of revisional powers and the binding nature of concurrent factual findings. (Para 10 , 11)
5. final confirmation of dismissal of the revision petition and affirmation of lower orders. (Para 14 , 16)

1. This revision petition under the Consumer Protection Act, 1986 (in short, the ˜Act') assails the order dated 1.9.2017 in Appeal No. 341 of 2017 of the State Consumer Disputes Redressal Commission, Punjab, Chandigarh (in short, the ˜State Commission') arising out of order dated 27.3.2017 in Consumer Complaint No. 320 of 2016 of the District Consumer Disputes Redressal Forum, Amritsar (in short, the ˜District Forum'). This order will also dispose of RP No. 3295 of 2017 which arises from the same order.

2. The facts, in brief, according to the revision petitioner / opposite party, are that the late husband of the respondent / complainant had obtained a life insurance policy from the petitioner on 31.10.2012 for an assured sum of Rs 25,00,000. On 3.11.2012 the insured expired suddenly. A claim was preferred by the respondent on 23.4.2014 after which the petitioner investigated since the death of the insured had occurred within 2 years of the policy being taken. During investigations it came to notice that the Deceased Life Assured (DLA) had concealed material evidence at the time of filling the proposal form relating to his hospitalization in Sri Guru Ramdas Hospital, Amritsar from 6.9.2012 to 7.9.2012 for Diagnostic Laparoscopy Biopsy prior to the issuance of the policy. It was also ascertained that the DLA was diagnosed with Sub Acute Intestinal Obstruction and that he was a known case of Non - Hodgkin Lymphoma. The claim was therefore repudiated on 16.7.2014. The respondent filed a consumer complaint No. 320 of 2016 which came to be decided on contest on 27.3.2017 with the District Forum upholding the complaint. The appeal before the State Commission against this order in Appeal No. 341 of 2017 was dismissed on 1.9.2017. This order is challenged in the instant petition.

3. The petitioner's case is that the DLA had deliberately not disclosed the fact of his hospitalization prior to the taking of the policy as per the proposal form which constituted suppression of a material fact. It is argued that the report of the medical examination done prior to the policy cannot be accepted in view of suppression of material evidence. Therefore, the claim had been rightly repudiated. The respondent has contended that the proposal form relied upon was unsigned and, therefore, not reliable. The fact of hospitalization is not denied although it was for a minor reason and that no evidence of the doctor concerned had been brought on record. According to the respondent, the affidavit of Ms Sunita Yadav, Associate Manager (Legal) relied upon by the petitioner could not be considered since she did not have first - hand knowledge of the facts. It is also contended that the policy was approved after the conduct of a medical examination which did not reveal any pre - existing illness.

4. The order of the District Forum noted that though the petitioner / opposite party brought the discharge summary of the DLA on record, they could not examine the doctor who treated him or of any doctor who treated the DLA prior to the taking of the policy. The District Forum order reads as under:
we are of the opinion that the Opposite Party has wrongly repudiated the claim of the complainants. Consequently, we allow the complaint with costs and the Opposite Party is directed to pay the claim amount of Rs 20 lacs (twenty lacs) to the complainants in equal shares, within one month from the date of receipt of copy of this order failing which the complainants shall be entitle

















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