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2021 Supreme(Online)(NCDRC) 84
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION
C. VISWANATH, PRESIDING MEMBER
LIFE INSURANCE CORPORATION OF INDIA – Appellant
Versus
REKHA JAIN – Respondent
REVISION PETITION NO. 850 OF 2020 | REVISION PETITION NO. 851 OF 2020 | REVISION PETITION NO. 852 OF 2020 | REVISION PETITION NO. 853 OF 2020 | REVISION PETITION NO. 854 OF 2020 | REVISION PETITION NO. 867 OF 2020
For the Appellants/Petitioners: Mr. Lakshay Sawhney
For the Respondents: Mr. Madhurendra Kumar
Non-disclosure of pre-existing health conditions in insurance applications can invalidate claims if substantiated, necessitating thorough evidence presentation in consumer disputes.
Headnote:(A) Consumer Protection Act - Sections pertaining to duty of disclosure in insurance policies - The court addressed the implications of non-disclosure of pre-existing diseases in insurance claims. Key issues included the legitimacy of claims made under false pretenses and the responsibilities of insurance underwriters when handling such claims. (Paras 2, 6, 8, 10)
(B) Jurisdiction of Consumer Fora - The court explored the statutory limits of consumer fora in accepting new evidence at various stages of the appeal process and emphasized the need for comprehensive evaluations based on all relevant evidence before reaching a conclusion. (Paras 8, 9)
Facts of the case:
The Complainant filed multiple insurance claims following the untimely death of her son, alleging deficiency of service by the insurer when claims for several policies were rejected on grounds of pre-existing health conditions that were not disclosed in the policy applications.
Findings of Court:
The court pointed out procedural irregularities regarding the handling of evidence concerning the insured’s health, emphasizing the need for the District Forum to reassess the case with all proper documentation related to the insured's medical history.
Issues: The primary issue was the failure to prove the insured's prior medical condition and whether it warranted the denial of claims based on the principles of good faith in insurance contracts.
Ratio Decidendi: The court ruled that the parties must supply adequate evidence, and observed that the failure to accept relevant medical records could lead to a miscarriage of justice in determining the validity of the insurance claims.
Result: Revision Petitions are allowed and the matter is remanded to the District Forum for a fresh decision based on all available evidence.
| Table of Content |
|---|
| 1. claims based on undisclosed health issues. (Para 2 , 3 , 4) |
| 2. need for reassessing evidence in claims. (Para 5 , 9 , 10) |
| 3. defense of claim denial based on alleged non-disclosure. (Para 6 , 7) |
| 4. need for remand for fresh evaluation. (Para 8) |
1. Above-mentioned six Revision Petitions have been filed by the Petitioner/Opposite Party against the order of Delhi State Consumer Disputes Redressal Commission (for short “the State Commission”) dated 24.06.2020 in First Appeal Nos.24 to 29 of 2020.
2. Facts of the case are that the Complainant/Respondent is the mother of the insured/deceased Rahul Jain, who took seven Insurance Policies bearing Nos.126175119, 126182682, 126182683, 127325623, 127325624, 127325625 and 127325638. Complainant was the nominee in all the Policies. Insured expired on 10.06.2014 and the Complainant filed Insurance claim before the Petitioner/Opposite Party. Insurance claim against Policy No.126175119 was honoured by the Petitioner, but the claim against rest six Insurance Policies was not paid. Complainant also made a representation for payment, but she did not receive any reply from the Opposite Party. Claiming deficiency in service on the part of the Petitioners/Opposite Parties, the Complainant filed six separate Consumer Complaints before the District Forum, making similar prayer in all the Complaints. Prayer in Complaint No.33/2017 (taking it as leading case herein) reads as follows: -
“A. It is therefore prayed that this Hon’ble Forum may kindly be pleased to take action against the respondents under the provisions of the consumer protection act, and the respondents may kindly be summoned, tried and punished in accordance of the laws for the offence committed by him in the interest of justice.
B. Pass an order/award for recovery/payment of claim of Rs.10,00,000/- (Rupees Ten Lakhs Only) for the insurance policy No.126182682 alongwith interest @ 24% per annum in favour of the complainant and against the respondent till realization.
C. It is also prayed that this Hon’ble Forum may be pleased to order to direct the respondents for the payment of the compensation of Rs.6,00,000/- (Rupees Six Lakhs Only) for the pain and suffering to the complainant in accordance of the laws.
D. Pass an order/award for Rs.50,000/- for legal expenses in favour of the complainant and against the respondents.
E. Pass an order/award for cost of the suit in favour of the complainant and against the respondents.
F. Pass any other relief/order/award or such other decrees, which this Hon’ble Court may deem fit and proper in the facts and circumstances of the case, in favour of the complainant and against the respondents.”
3. Complaint was contested by the Petitioners/Opposite Parties. It was stated that the insured while filling the proposal form, had supressed the material fact about his health condition. The life assured was having history of Hypothyroid and Diabetes from 2010 to June, 2014 before taking the Policy, for which he had taken treatment in AIIMS, Delhi. Life assured was also suffering from DCMP with EF-21% for 5 years and was on regular treatment from AIIMS, New Delhi from 2010 to June, 2014. The claim of the Complainant was, therefore, repudiated and the same was communicated to the Complainant, vide letter dated 12.03.2015.
4. The District Forum, vide separate orders dated 18.12.2019, allowed the Complaints and directed the Petitioners/Opposite Parties as follows:-
“i) Pay to the complainant a sum of Rs.10,00,000/- (sum assured) alongwith 9% interest from the date of filing of complaint i.e. 18.1.2017 till realization.
ii) Pay to the Complainant a sum of Rs.10,000/- on account of mental agony and harassment which will also include the cost of litigation.”
5. Aggrieved by the impugned orders, Opposite Parties preferred six separate Appeals before the State Commission. State Commission, vide common order dated 24.06.2020 dismissed all Appeals.
6. Aggrieved by the above orders, the present Revision Petitions have b
