STATE CONSUMER DISPUTE REDRESSAL COMMISSION MAHARASHTRA, AT MUMBAI Appeal No. A/22/779 (Arisen out of order dated 10/06/2022 passed in consumer complaint No. CC/2020/105 by District Consumer Disputes Redressal Commission, Ce ntral Mumbai)

SBI General Insurance Gr. Floor, People’s Education Society, Pr. NM Kale Marg, Gokhale Road, Dadar West, Mumbai – 400028 Appellants/Org.

Opponent V/S

1. Mandar Tambe Flat No. 24, Venus CHS Ltd., Dr. R.G. Thadani Marg, Worli Sea Face, Mumbai – 400018 Respondent/Org.

Complainant

2. Paramount Healthcare Services Pvt. Ltd.

Plot No. A-442, Road No. 28, Ram Nagar, M.I.D.C. Industrial Area, Wagle Estate, Thane – West - 400604 Respondent/Org.

Opponent no.2 BEFORE:

Hon’ble Mr. Mukesh V. Sharma : Presiding Member Hon’ble Ms. Poonam Maharshi : Member For the The learned Advocate Shri. Rajesh Appellant :

Kanojia is present for appellant.

For the Respondent : The learned Advocate Shri. Mihir Tambe for the respondent.

JUDGMENT (29/08/2024)

Per: Hon’ble Mr. Mukesh V. Sharma – Presiding Member –

1. The present appeal has been filed by SBI General Insurance Company Ltd., challenging the order dated 10.06.2022 passed by the District Consumer Disputes Redressal Commission, Central Mumbai, in Consumer Complaint No. 105 of 2020. By the impugned order, the District Commission directed the appellant to reimburse an amount of ₹5,91,981/- along with interest at the rate of 9% per annum to the respondent no. 1, Mr. Mandar Tambe, from 20.12.2019 until realization, as well as compensation of ₹25,000/- towards mental agony and inconvenience and ₹10,000/- towards litigation costs.

2. The appellant, in its memorandum of appeal, mainly contends that the District Commission erred in its judgment by disregarding the pre- existing medical condition of the respondent, which was allegedly established through the medical records provided. The appellant states that the respondent had concealed material facts regarding his medical history, particularly his prior treatment for back pain, which the appellant argues should have disqualified him from receiving the insurance benefits claimed.

3. Additionally, the appellant raises objections to the authenticity of the rectification letter obtained by the respondent from the treating doctor, alleging that it was a fabricated document created after the insurance claim was repudiated. The appellant argues that the District Commission wrongly relied on this document without requiring the respondent to produce the treating doctor for examination.

4. On the other hand, the respondent refutes these claims, emphasizing that the initial medical examination conducted by the appellant’s own doctor at the time of policy issuance revealed no deformities or issues with the respondent's spine. The respondent argues that the appellant's repudiation of the claim was unjustified and based on an incorrect interpretation of the medical records.

5. Furthermore, the respondent has raised a significant preliminary objection regarding the maintainability of the appeal, contending that it was not filed by a duly authorized person. The respondent has provided detailed arguments highlighting the technical loopholes in the power of attorney used to file the appeal, asserting that the document was not properly stamped, improperly notarized, and not executed according to legal requirements. The respondent has referred to the judgment in Sri Sandip Ghosh vs Sri Subimal Chowdhury & Ors in support of his arguments regarding the invalidity of the power of attorney.

6. Upon careful consideration of the records, submissions, and evidence presented, it is not disputed that respondent is a ‘consumer’ of the insurance services provided by the appellant. The policies in question were valid and in force during the period of treatment, with the appellant accepting premium payments for the renewal of the Arogya Plus and Arogya Top-Up policies, thereby establishing a clear contractual relationship.

7. The District Commission critically examined th