JUSTICE SUDIP AHLUWALIA, MEMBER

2. The factual background, in brief, is that the Complainant is the widow of late Sunil Kumar, who passed away on 06.12.2007. Before his death, Sunil Kumar had taken a loan of Rs. 7,75,641/- from Citi Financial Consumer Finance India Ltd. on 29.01.2007. During the loan application process, the officials of the Finance Company made Sunil Kumar sign various documents, including some blank papers. Later, Sunil Kumar discovered that the amount financed was shown as Rs. 7,90,000/- which was higher than the actual loan amount. Upon inquiry, he learned that the Finance Company had obtained an Insurance Policy on his behalf from the Respondent Company, with a sum insured of Rs. 3,00,000/-. The difference in the loan amount was due to the Insurance Premium for this Policy, which was valid from 15.02.2007 for one year.  Sunil Kumar, being in urgent need of money, had no choice but to accept the Insurance Policy, which was taken by the Finance Company without his prior knowledge. Tragically, Sunil Kumar passed away during the validity of the Insurance Policy. Upon his death, the Complainant submitted the necessary Claim documents to the Respondent Company, requesting payment of the insured amount.

 

3. However, the Respondent Company rejected the death Claim, stating that Sunil Kumar had been suffering from Diabetes and heart problems since 2006, and had undergone coronary bypass surgery on 06.04.2006. The Respondent Company claimed that these pre-existing conditions were not disclosed in the Insurance Proposal Form dated 02.02.2007, which was the basis for their rejection of the Claim.

4. Following the rejection of the Claim, the Complainant sent a Legal Notice to the Claim Review Committee of the Respondent Company on 19.04.2008. The Committee responded by repudiating the Claim again on 23.06.2008, without providing any valid reason. Aggrieved with the deficiency of service and unfair trade practice by the Petitioner Insurance Company, the Complainant filed her Complaint before the Ld. District Forum, Sheikh Sarai, Delhi.

5. The  District  Forum  vide  its  Order  dated 05.04.2011  allowed the  Complaint and directed the Petitioner/Insurance Company to pay Rs. 3,00,000/- to the Complainant with interest @9% p.a. from 06.12.2007 till realization, along with Rs. 5,000/- towards mental agony and Rs. 2,000/- towards cost of litigation. The Petitioner then filed Appeal before the Ld. State Commission, which was dismissed and the Order of the District Forum was affirmed. 

6. This Commission has heard the Ld. Counsel for Petitioner and Respondent, and perused the material available on record.

 

7. The contention of the Petitioner/Insurance Company is that the Claim raised by the Complainant on account of the death of Insured Sunil Kumar was untenable because of the false declaration made by him regarding his health condition, in the Proposal Form submitted by him for taking the Insurance Policy.  Attention has been drawn to the fact that in the said Form, the Insured stated nothing about any disease/disorder of the Cardio Vascular System and also represented that he had not received any medical advice, nor undergone any advanced medical tests or investigation in the last five years, nor had taken any medical advice on health, or care in the hospital.  Thus, according to the Petitioner the deceased had violated the fundamental principle of ‘uberrima fides’ by supressing the earlier history of his heart related ailments.

8. In opposing the contention of the Petitioner, the Respondent side has first of all relied upon the decision of the Hon’ble Supreme Court in the case of “Sulbha Prakash Motegaonkar & Ors. vs. Life Insurance Corporation of India, CA No. 8245 of 2015” in which it was held that unless the ailment the deceased was suffering from could be linked to the cause of death, it should not be a ground for rejecting the Insurance Claim. In the present case, Sunil Kumar's death was not due to Diabetes or any complications from his alleged past bypass surgery.

9. Attention has also been drawn to the decision of this Commission in “Neelam Chopra vs. Life Insurance Corporation of India, RP No. 4461 of 2012”, in which it was similarly held that even if there was suppression of certain information in the Proposal Form, it would not lead to the denial of the insurance claim if the suppressed information was not related to the cause of death. In this case, Sunil Kumar's death was due to natural causes, and not due to Diabetes or the bypass surgery he had allegedly undergone.

10. At any rate, Ld. Counsel for Respondent further argued that in “LIC of India vs. Priya Sharma, RP No. 2615 of 2011”, which has facts similar to this case, this Commission held that the onus to prove that the Insured was suffering from a pre-existing disease lies with the Petitioner/Insurance Company. The Petitioner had not provided any medical evidence or testimony from any Doctor to prove that Sunil Kumar was suffering from such a condition at the time the policy was taken. 

11. On a careful perusal of the available material on record, it is seen that there is a major discrepancy regarding the identity of the deceased “Mr. Sunil”, as being the same person as the Insured “Sunil Kumar”.  This is so because on perusal of the Proposal Form submitted by the Insured (Annexure-P3), it is seen that the said Sunil Kumar’s father happens to be one Om Prakash, and his address was RZ-119, Shiv Block, Raghu Nagar, New Delhi- 110045, and his phone number was 9899225004.  On the other hand, the Discharge Summary from the Delhi Heart and Lung Institute relied upon by the Petitioner Insurance Company goes to show that the name of the concerned patient was “Mr. Sunil”.  There is no mention about his father’s name in the said Discharge Summary and his address is shown as “RZ 30A, Ist Floor, Raghu Nagar, New Delhi and his phone number was 9810719057.  In view of such visible differences in the addresses of the Proposer, and the patient as claimed by the Insurance Company, coupled with the fact that even the father’s name of the patient in “Delhi Heart and Lung Institute” has not been revealed, there would appear to be serious  doubt in concluding that the said patient was the same “Sunil Kumar” who had submitted the original Proposal Form.  This Commission is of such view, especially considering that the Investigator who had allegedly collected the information from the Hospital, was not examined from the Petitioner’s side nor his Affidavit filed.  Furthermore, no Doctor was examined to prove that the patient “Mr. Sunil” was the same person as the deceased “Sunil Kumar”.

12. Even otherwise, the Hon’ble Apex Court in “Rajiv Shukla Vs. Gold Rush Sales and Services Ltd. & Anr., Civil Appeal No. 5928 of 2022, decided on September 8, 2022”; in this regard has observed inter alia –

 “7.1 At this stage, it is required to be noted that on appreciation of evidence on record the District Forum as well as the State Commission concurrently found that the car delivered was used car.  Such findings of facts recorded by the District Forum and the State Commission were not required to be interfered by the National Commission in exercise of the revisional jurisdiction.  It is required to be noted that while passing the impugned judgment and order the National Commission was exercising the revisional jurisdiction vested under Section 21 of the Consumer Protection Act, 1986.  As per Section 21(b) the National Commission shall have jurisdiction to call for the records and pass appropriate orders in any consumer dispute which is pending before or has been decided by any State Commission where it appears to the National Commission that such State Commission has exercised its jurisdiction not vested in it by law, or has failed to exercise a jurisdiction so vested, or has acted in the exercise of its jurisdiction illegally or with material irregularity.  Thus, the powers of the National Commission are very limited.  Only in a case where it is found that the State Commission has exercised its jurisdiction not vested in it by law, or has failed to exercise the jurisdiction so vested illegally or with material irregularity, the National Commission would be justified in exercising the revisional jurisdiction.  In exercising of revisional jurisdiction the National Commission has no jurisdiction to interfere with the concurrent findings recorded by the District Forum and the State Commission which are on appreciation of evidence on record.  Therefore, while passing the impugned judgment and order the National Commission has acted beyond the scope and ambit of the revisional jurisdiction conferred under Section 21 (b) of the Consumer Protection Act.”

 

13. Again in Mrs. Rubi (Chandra) Dutta Vs. M/s United India Insurance Co. Ltd., Civil Appeal No. 2588 of 2011, decided on 18.3.2011, the Apex Court had set aside the decision of this Commission by virtue of which the concurrent decisions of the Ld. District Forum and the State Commission, which had gone in favour of the Complainant, were set aside with the following observations –

“23. Also, it is to be noted that the revisional powers of the National Commission are derived from Section 21 (b) of the Act, under which the said power can be exercised only if there is some prima facie jurisdictional error appearing in the impugned order, and only then, may the same be set aside. In our considered opinion there was no jurisdictional error or miscarriage of justice, which could have warranted the National Commission to have taken a different view than what was taken by the two Forums.  The decision of the National Commission rests not on the basis of some legal principle that was ignored by the Courts below, but on a different (and in our opinion, an erroneous) interpretation of the same set of facts.  This is not the manner in which revisional powers should be invoked.  In this view of the matter, we are of the considered opinion that the jurisdiction conferred on the National Commission under Section 21 (b) of the Act has been transgressed.  It was not a case where such a view could have been taken by setting aside the concurrent findings of two fora.”

 

14. Consequently, this Commission finds no grounds whatsoever to interfere with the concurrent decisions of both the Ld. Fora below.  The Revision Petition is therefore dismissed.  Parties to bear their own costs. 

15. Pending application(s), if any, also stand disposed off as having been rendered infructuous.