NCDRC

NCDRC

RP/851/2010

TATA AIG LIFE INSURANCE CO. LTD. - Complainant(s)

Versus

DHRUV SHARMA - Opp.Party(s)

M/S. RAKESH MALHOTRA & ASSOCIATES

27 Aug 2010

ORDER


NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSIONNEW DELHIREVISION PETITION NO. 851 OF 2010
(Against the Order dated 05/10/2009 in Appeal No. 1260/2009 of the State Commission Karnataka)
1. TATA AIG LIFE INSURANCE CO. LTD.Through its Manager Legal, Situated at 2nd Floor, Delphi B- Wing, Arcade Avenue, Hiranandani Business Park, PowaiMumbai - 400076Maharashtra ...........Petitioner(s)
Versus
1. DHRUV SHARMAResiding at 37/38, Ashinia, Kurubara Halli, KHB SocietyBanglore - 560086Karnataka ...........Respondent(s)

BEFORE:
HON'BLE MR. JUSTICE R.C. JAIN ,PRESIDING MEMBERHON'BLE MR. SURESH CHANDRA ,MEMBER
For the Petitioner :NEMO
For the Respondent :NEMO

Dated : 27 Aug 2010
ORDER

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For the Petitioner : Mr. Rakesh Malhotra, Advocate For the Respondent : Mr. Kashi Vishwaeshwar, Advocate

 Dated, the 27th day of August, 2010

ORDER

28 days delay in filing the present revision petition is condoned. 2. Through this revision petition purportedly u/s 21(b) of the Consumer Protection Act, 1986, the TATA AIG life insurance Co. Ltd. opposite party in the complaint, seeks to challenge the order dated 5.10.09 passed by the Karnataka State Consumer Disputes Redressal Commission, Bangalore (in short, ‘the State Commission) ..2.. in appeal no.1260/09. By the impugned order, the State Commission has dismissed the appeal filed by the petitioner herein and has affirmed the order dated 16.03.09 passed by the District Forum in complaint no. 2365/08. By the said order, the District Forum had allowed the complaint filed by the complainant and had directed the insurance company to pay the insurance amount of Rs. 4 lakh along with interest @ 8% p.a. from the date of death of the baby till realization besides awarding a sum of Rs.3,000/- as costs. 3. We have heard Mr. Rakesh Malhotra, learned counsel for the petitioner and Mr. Kashi Vishweshwar, learned counsel for the respondent and have considered their respective submissions. The consumer dispute raised before the fora below related to the non-settlement of an insurance claim under an insurance policy which the complainant took for her newly born female child on 12.05.06 in the sum of Rs.4 lakh and the child died on 28.07.06 at Manipal Hospital after a prolonged illness and treatment. The claim was repudiated by the insurance company primarily on the ground that the proposer had concealed the material fact in regard to the child suffering from a pre-existing ailment of “brocho-pneumonia/interstitial ..3.. lung disease” for about a month prior to taking the policy and, therefore, the insurance company was within its right to revoke the policy in exercise of its right u/s 45 of the Insurance Act 1938. The complaint filed was also resisted on the same very ground. Although several documents including a certificate dated 31.10.06 issued by Dr. Pramod G. Shanbag as also the discharge summary and detailed record of the treatment which the child received at Manipal Hospital, were produced on record to show that the insured child was suffering from such a disease but the fora below discarded the said material simply on the ground that only photo copy of the certificate dated 31.10.06 was produced and neither the affidavit of Dr. Pramod G. Shanbag who issued the certificate was filed nor the doctor was examined and accordingly allowed the complaint and directed the insurance company to pay the insured amount along with interest. 4. Learned counsel for the appellant on the strength of the decisions of the Hon’ble Supreme Court in the cases of P.C. Chacko and another vs. Chairman, Life Insurance Corporation of India & others [(2008) 1 SCC 321] and Satwant Kaur Sandhu vs. New ..4.. India Assurance Company Limited [(2009) 8 SCC 316, has emphatically argued that this is a patent case where the pre-existing ailment of the insured child has been suppressed by the proposer and, therefore, the fora below have committed grave error in allowing the complaint. On the other hand, contention of the learned counsel for the respondent/complainant is that there was no suppression of any material fact at the time of taking the policy as the insured child was not suffering from any ailment as on the date of making proposal and in any case it has not been established by means of any cogent or reliable evidence placed by the appellant on record. 5. Having considered the entirety of the facts and circumstances, more particularly, that only a photo copy of the certificate dated 31.10.06 purportedly issued by Dr. Pramod G. Shanbag was placed on record and the treatment of the child at the Nursing Home or any other medical centre found mentioned in the discharge summary of Manipal Hospital dated 10.07.06 was not produced, we consider it expedient in the interest of justice to remit back the matter to the District Forum for deciding the complaint afresh after giving an opportunity to the appellant insurance company ..5… to produce the Dr. Pramod G. Shanbag for examination as also any further record of the treatment of the child at the said Nursing Home or at any other medical centre from April, 2006 onward subject to the right of the respondent/complainant to lead any evidence in rebuttal. 6. In the result, the revision petition is partly allowed and the orders passed by the fora below are hereby set aside and the complaint is remitted back to the concerned District Forum for deciding the same afresh after affording opportunity to the petitioner insurance company to lead further evidence and to produce the doctor which will be of course subject to rebuttal by the complainant. Parties are directed to appear before the District Forum on 4.10.10 to receive further directions in the matter. The District Forum shall endeavour to decide the complaint within three months of the said date. The revision petition stands disposed of. Costs made easy.



......................JR.C. JAINPRESIDING MEMBER
......................SURESH CHANDRAMEMBER