IN THE NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NEW DELHI REVISION PETITION NO. 655 OF 2017 (Against the Order dated 13/12/2016 in Appeal No. 891/2012 of the State Commission, Delhi) Smt. Brijinder Kaur Uberoi C-145, Manu Apartment, MayurVihar, Phase-I, Delhi. Petitioner (s)

Versus National Insurance Co. Ltd.

Delhi Regional Office-ll, 2E/9, Jhandewalan Extension, New Delhi-110055. Respondent (s)SRQPONMLKJIHGFEDCBA BEFORE:

HON'BLE DR. INDER JIT SINGH, PRESIDING MEMBER HON’BLE JUSTICE DR. SUDHIR KUMAR JAIN, MEMBER For the Petitioner Mr. Salil Paul, Advocate (VC)

For the Respondent Mr. Apoorv S. Chaudhary, Advocate (VC)

Dated : 07.04,2026 ORDERtsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA

1. The present Revision Petition (RP) has been filed by the Petitioner against Respondent as detailed above, under section 21(b) of Consumer Protection Act, 1986 against the judgment dated 13.12.2016 of the State Consumer Disputes Redressal Commission, Delhi (hereinafter referred to as the ‘State Commission’), in First Appeal (FA) No.891/2012 in which order dated 01.08.2012 of District Consumer Disputes Redressal Commission, Delhi (hereinafter referred to as District Commission) in Consumer Complaint (CC) No.947/2010 was challenged, inter alia praying for setting aside the order dated 13.12.2016 passed by the State Commission in FA No.891/2012.

2. While the Revision Petitioner (hereinafter also referred to as Petitioner) was Respondent before the State Commission and Complainant before the District Commission, the Respondent(s) (hereinafter also referred to as OP/lnsurance Company) was Appellant before the State Commission and Opposite Party before the District Commission. Notice was issued to the Respondent(s) on 05.05.2017. Parties filed Written Arguments on 04.09.2024

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(Petitioner) and 03.09.2024 (Respondent) respectively. For the sake of convenience, parties will also be referred to as they were arrayed before the District Forum.

3. Heard counsel for both the sides. Challenge is to order dated 13.12.2016 of the State Commission vide which First Appeal filed by the Respondent/lnsurance Company was allowed and order of the District Commission was set aside and Complaint was dismissed. Earlier, the District Commission, vide its order dated 01.08.2012, have allowed the Complaint stating that the Complainant is entitled to the expenses of US$ 19,662. The Opposite Party was directed to reimburse the claim of the Complainant for this amount.

4. The claim was repudiated by the Insurance Company vide letter dated 16.07.2010 on the ground of non-disclosure of material facts with respect to the pre-existing disease. Our attention was drawn to this letter dated 16.07.2010 at page no.102. First of all, we note that the repudiation letter is not issued by the Insurance Company itself but by Heritage Health TPA Pvt. Ltd. Ideally, as the insurance contract is between the Insurance Company and the insured, such repudiation letter should have been issued by the Insurance Company itself and not by a TPA. The TPA, at the most, can give its recommendation/suggestions to the Insurance Company. In any case, considering that case has proceeded at various levels and Insurance Company has taken a stand that the repudiation is on the ground of non- disclosure of material facts with respect to pre-existing disease, we take up the case further to see whether such grounds for repudiation of the claim by the Insurance Company are sustainable or not.

5. Our attention was drawn to the proposal form at page no. 49 onwards. At page-50, the insured made certain disclosures with respect to check-up by Dr. Kamal Kant Kapoor, M.D. and Sr. Cardiologist/Consultant, Apollo Hospital, Delhi. Further, the policy was issued after the medical examination by Dr. Pawan Deep S. Kohli, who has declared the insured fit to travel. Our attention

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was drawn towards medical documents/treatment records of the Valley Hospital at page no.65-67 as well as documents at page no.74-