1.      This Revision Petition No.277 of 2020 has been filed against the impugned order of Karnataka State Consumer Disputes Redressal Commission, Bengaluru (‘State Commission’) dated 16.10.2019. Vide this order, the State Commission dismissed Appeal No. 543 of 2018 and affirmed the District Consumer Disputes Redressal Forum, Vijayapur (‘District Commission’) order dated 20.01.2016 wherein the complaint was dismissed.

2.      For Convenience, the parties in the matter are being referred to as mentioned in the Complaint before District Forum.

3.      Brief facts of the case, as per the Complainant, are that her daughter, Laxmi Sukhadev Gayakawad, had obtained a life insurance policy No. 636172797 from OP-insurance company on 18.01.2011. The policy was valid until 17.01.2060, and the quarterly premium was Rs. 1,705. The sum assured was Rs.4,00,000. The policy included a "Double Accident Benefit" clause, which entitled the beneficiary to receive an additional sum assured in case of death due to accident. The complainant, Bharati Shrimant Masuti, was named the nominee under the policy.  Unfortunately, Laxmi Sukhadev Gayakawad died on 26.01.2015 in an accident. The complainant applied for the benefits on 18.03.2015. The OP paid Rs.4,00,000, which was the basic sum assured. However, she contended that since the policy specifically included the "Double Accident Benefit," the OP was also obligated to pay an additional Rs.4,00,000 towards accidental death of the life assured. The complainant alleged that the OP insurer violated the terms and conditions of the policy by refusing to pay the accident claim and exhibited deficiency in service by not paying the double accident benefit. Consequently, the complainant filed the complaint before the District Forum.

4.      The OP in its written version before the District Forum admitted the factum of the policy and that the sum assured of Rs.4,00,000 and, however, objected to the claim for the double accident benefit. The OP contended that while Complainant reported the cause of death as fall from bike, however. As per policy conditions, to claim double accident benefit, the claimant must produce records such as a police report or hospital records to prove that the death was due to accident. Since necessary documents were not submitted, the OP rejected the double accident benefit claim and only paid the basic sum assured of Rs.4,00,000, along with additional Rs.90,084. OP asserted that there was no deficiency in service and that the rejection of double accident benefit was in accordance with policy terms. They prayed for the dismissal of the complaint.

5.      The learned District Forum vide order dated 07.03.2018, dismissed the complaint with the following reasons:

“8)  Heard the argument, perused the records the following points dues arise for our consideration in deciding the case is as under:-

1) Whether the complainant is entitled for the reliefs as sought for?

2) What order?

9)     Answer to the above points.

1) Negative.

2) As per Final order.

REASONS

10) Point No.1:- It is admitted fact by both the parties that complainant daughter by name Laxmi Sukhadev Gayakwad during her life taken LIC policy bearing No. 636172797 dtd:18/01/2011 which is valid for the year 18/01/2011 to 17/01/2060. She was regular in payment of premium and the said policy sum assured was Rs.4,00,000. The said policy is Double Accident Benefit under the policy, Complainant got Double Accidental death benefit Rs.4,00,000/- + 4,00,000/-

11) The complainant alleged that complainant daughter died on 26/01/2015 due to fall from bike this fact is evident by the Ex.C-2 & C-9. According to complainant this is an accidental death, hence complainant entitled to get Double Accidental Benefit as per the policy prayed for the same.

12) But on the other side, Advocate appeared for Op Company, they submit that the policy in question is Double Accidental benefit policy. But complainant's daughter not died in accident, if she died in accident the complainant ought to have proved the FIR, Post Mortem report or medical bills etc., Hence, in this case complainant not produced any document to prove that deceased died in accident. Complainant examined CW-2 and CW-3, who deposed that deceased Laxmi died due to fall from bike, they nowhere stated that deceased died in accident either by complainant or CW-2 and CW-3. No complaint was registered no case was made, in the absence of such necessary documents. We cannot hold that the deceased died in accident.

13)  Therefore, without proof Op company rejected the claim under Double Accidental Benefit only he paid sum assured in the policy to the complainant this Ops act is legal and there is no deficiency in service by the Op towards complainant only with a view to get relief under the policy she made false case.

14)      Hence, we hold that complainant is not proved his case to get relief under the policy. Hence, we answer to the point No.1 as negative.

15) Point No.2:- In view of the above discussion at point No.1 we proceed to pass the following order.

ORDER

1) The complaint of the complainant is dismissed. No order as to costs.

2) Free copy of this order shall be sent to the parties immediately.”

6.      Being aggrieved by the impugned order, the Petitioner filed an Appeal and the learned State Commission, vide order dated 16.10.2019 dismissed the Appeal and observed as follows:

 “Heard the counsel for both the parties.

 The complainant's daughter assured her life with the OP under policy No.636172797 on 18.01.2011, which is Valid from 18.01.2011 to 17.01.2060. The life assured Laxmi Sukhadev Gayakawad died on 26.01.2015 due to fall from bike, according to complainant this is an accidental death hence complainant is entitled to get Double Accidental Benefit as per the policy. The complainant is made as nominee to the said policy for a sum assured sum of Rs.4,00,000/-.

 The complainant applied for benefits on 18.03.2015. OP paid a sum of Rs.4,00,000/- sum assured, but under the policy, OP ought to pay Rs.4,00,000/- under "Double Accident Benefit". OP already a sum of Rs.4,00,000/- is said to have been settled to the complainant.

 The complainant's daughter died due to fall from bike, no complaint was registered and no case was made. No document regarding P.M. report is produced by the complainant. Under the circumstances no scope for interference in the order passed by the District Forum. Hence the following;

ORDER

          Appeal is dismissed.”

7.      In her arguments, the learned Amicus Curiae for the Petitioner reiterated the grounds in the Revision Petition, emphasizing that the Fora below failed to appreciate the fact that her daughter died due to a fall from a bike. She highlighted that the complainant had presented witnesses in support of her claim. This was specifically acknowledged by the District Forum in its order. Even if the State Commission believed the Petitioner’s evidence was insufficient to conclusively prove that the death was accidental, she should have been granted opportunity to present oral arguments through counsel to strengthen her case. She argued that the Fora below did not apply proper judicial reasoning, as they overlooked the fact that lodging an FIR or conduct of a post-mortem are not mandatory to establish the cause of death in such cases. Importantly, she pointed out that the respondents had not contested the claim that the death resulted from an accident. She sought the Revision Petition to be allowed.

8.      On the other hand, the learned Counsel for the Respondent/OP supported the concurrent findings of the Fora below and argued that the admitted facts in the case cannot be reversed under the limited scope of Revision jurisdiction, as established by the Hon’ble Supreme Court. As per policy conditions, in order to claim double accident benefit, the claimant is required to provide evidence such as police reports or hospital treatment records that clearly indicate the life assured sustained accidental injuries. These are necessary to satisfy the Corporation's requirements under the policy. In the absence of basic evidence in this case, the learned Counsel for the Respondent urged the Court to dismiss the present Revision Petition with costs.

9.      I have examined the pleadings and associated documents placed on record and rendered thoughtful consideration to the arguments advanced by the learned Amicus Curiae for the Petitioner and the learned Counsel for the Respondent.

10.    It is undisputed that Ms Laxmi Sukhadev Gayakawad, the daughter of the Complainant, had obtained a life insurance policy No. 636172797 from OP-insurance company on 18.01.2011. The policy was valid until 17.01.2060, and the sum assured was Rs.4,00,000. The policy included a "Double Accident Benefit" clause, which entitled the beneficiary to receive an additional sum assured in case of death due to accident. The complainant is the nominee under the policy.  It is also undisputed that during the course of validity of the policy, Ms Laxmi Sukhadev Gayakawad died on 26.01.2015. On the claim of the Complainant on 18.03.2015, the OP had paid Rs.4,00,000, which was the basic sum assured with respect to the policy. The main contention of the Complainant is that since the policy included the "Double Accident Benefit," the OP was bound to pay an additional Rs.4,00,000 towards accidental death of the life assured. The OP, however, repudiated the claim on the grounds that while the death of the life assured as established, the claim of accident resulting in death was uncorroborated. It is undisputed that the Complainant has not brought on record the FIR, medical treatment records, post-mortem report etc to establish the claim of accident and no plausible reasons are stated. In the absence of establishing the claim of accidental nature of death of the life assured, the action of OP in paying the basic sum assured does not reflect any violation of terms and conditions of the policy. The learned District Forum issued a well-reasoned order based on evidence and arguments advanced before it. The learned State Commission, after due consideration of the pleadings and arguments, determined that no intervention is warranted on the District Forum's order. Also in the present case, the petitioner made out no ground by producing any evidence to substantiate the claim for interference in the impugned orders passed by both the said fora. Under these circumstances, I find no reason to interfere with the detailed and well-reasoned orders of learned District Forum and State Commission.

11.    It is a well settled position in law that the scope for Revision under Section 21(b) of the Consumer Protection Act, 1986 and now under Section 58(1)(b) of the Act, 2019 confers very limited scope and jurisdiction on this Commission. In the present case, there are concurrent reasoned findings of the facts and the revisional jurisdiction of this Commission is limited. After due consideration of the entire material, I do not find any illegality, material irregularity or jurisdictional error in the impugned Order passed by the learned State Commission warranting our interference in revisional jurisdiction under the Act. I place reliance on the decision of Hon’ble Supreme Court in the case of ‘Rubi (Chandra) Dutta Vs. M/s United India Insurance Co. Ltd., (2011) 11 SCC 269.

12.    In addition, Hon’ble Supreme Court in ‘Sunil Kumar Maity vs. SBI & Anr.  Civil Appeal No. 432 OF 2022 Order dated 21.01.2022 observed as follows:-

“9. It is needless to say that the revisional jurisdiction of the National Commission under Section 21(b) of the said Act is extremely limited. It should be exercised only in case as contemplated within the parameters specified in the said provision, namely when it appears to the National Commission that the State Commission had exercised a jurisdiction not vested in it by law, or had failed to exercise jurisdiction so vested, or had acted in the exercise of its jurisdiction illegally or with material irregularity. In the instant case, the National Commission itself had exceeded its revisional jurisdiction by calling for the report from the respondent-bank and solely relying upon such report, had come to the conclusion that the two fora below had erred in not undertaking the requisite in-depth appraisal of the case that was required. .....”

13.    Similarly, the Hon'ble Supreme Court in Rajiv Shukla Vs. Gold Rush Sales and Services Ltd. (2022) 9 SCC 31 has held that:- 

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.

14.    Based on the deliberations above, I do not find any merit in the present Revision Petition No. 277 of 2020 is, therefore, Dismissed.

15.    All pending Applications, if any, also stand disposed of accordingly.