The insurer must prove suppression of material facts for claim repudiation; mere allegation is insufficient, and burden of proof lies on the insurer.

ORDER

1. The present Revision Petition (RP) has been filed by the Petitioner against Respondents as detailed above, under section 21(b) of Consumer Protection Act 1986, against the order dated 10.10.2017 of the State Consumer Disputes Redressal Commission, Rajasthan (hereinafter referred to as the ‘State Commission’), in First Appeal (FA) No. 302/2017 in which order dated 04.01.2017 of District Consumer Disputes Redressal Forum, Jaipur (hereinafter referred to as District Forum) in Consumer Complaint (CC) No. 1566/2014 was challenged, inter alia praying for setting aside the order passed by the State Commission in FA/302/2017.

2. The Revision Petitioner (hereinafter also referred to as Complainant) was Respondent before the State Commission and Complainant before the District Forum and the Respondents (hereinafter also referred to as Opposite Parties) were Appellants before the State Commission in FA/302/2016 and Opposite Parties before the District Forum in Complaint No. 1566/2014.

3. Notice was issued to the Respondent(s) on 03.04.2018. Parties filed Written Arguments on 03.10.2023 (Petitioner) and 27.09.2023 (Respondents) respectively.

4. Brief facts of the case, as presented by the Complainant and as emerged from the RP, Order of the State Commission, Order of the District Forum and other case records are that: -

The Petitioner/complainant took mediclaim policy from Oriental Insurance Company on 18.07.2009, for a period from 18.07.2009 to 17.07.2010. Thereafter, the Petitioner, under the portability scheme, got the Mediclaim Policy transferred to National Insurance Company and the same was initially for the period w.e.f. 18.07.2010 to 17.07.2011 and thereafter renewed for the period w.e.f. 18.07.2011 to 17.07.2012. The Petitioner, his wife and two daughters were covered under the said Mediclaim Policy. The Petitioner paid Rs.28,050/- towards premium of the said Policy. The wife of the Petitioner fell ill and was taken to hospital at Jaipur for treatment. After conducting tests, the doctor diagnosed that she is suffering from Advance Parkinson and advised the Petitioner to get his wife treated at Jaslok Hospital, Mumbai. Accordingly Petitioner’s was admitted in Jaslok Hospital, Mumbai on 07.04.2014. She underwent surgery at Jaslok Hospital, Mumbai on 09.04.2014 and was discharged on 17.04.2014. The Petitioner spent Rs.16,06,946/- on treatment of his wife. The Petitioner filed claim with the Insurance Company/Respondents herein on 30.04.2014. The Respondents repudiated the claim vide letter dated 18.06.2014 on the ground that the wife of Petitioner was suffering from Parkinson disease, which was not disclosed at the time of taking the Mediclaim Insurance Policy. The Mediclaim Policy was renewed for further period w.e.f. 18.07.2014 to 17.07.2015. The Petitioner paid Rs.33,095/- towards the premium. Petitioner requested the Insurance Company to provide copy of the medical examination of his family done by their authorized Doctor at the time of taking the Mediclaim policy, Respondent-1 vide its email dated 17.11.2014 alleged that on the basis of the request of the Petitioner, the Mediclaim Policy has been cancelled and the premium amount shall be refunded within 10 working days. The Petitioner vide email dated 18.11.2014 denied that he ever had requested for cancellation of the Mediclaim Insurance Police. Being aggrieved by illegal and arbitrary repudiation of claim, the Petitioner filed complaint before the District Forum.

5. Vide Order dated 04.01.2017 the District Forum allowed the complaint CC No. 1566 of 2014. Aggrieved by the said Order dated 04.01.2017 of Dist