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 10.04.2019 of the State Consumer Disputes Redressal Commission, Maharashtra, Circuit Bench Nagpur (hereinafter referred to as the ‘State Commission’), in First Appeal (FA) No. 267 of 2015  in which order dated 12.03.2015 of District Consumer Disputes Redressal Forum, Nagpur (hereinafter referred to as District Forum) in Consumer Complaint (CC) No. 142 of 2012 was challenged, inter alia praying for setting aside the impugned judgment dated 10.04.2019 of State Commission in FA/267/2015. 

2.       While the Revision Petitioner (hereinafter also referred to as OP/Insurance Company) was Respondent and the Respondents (hereinafter also referred to as Complainants) were Appellants in the said FA/267/2015 before the State Commission, the Revision Petitioner was OP and Respondents were Complainants before the District Commission in the CC No. 142 of 2012.  For the sake of convenience, the parties will be referred to as they were arrayed before the District Forum. Notice was issued to the Respondents on 27.08.2019.  Parties filed Written Arguments/Synopsis on 25.04.2023 and 15.03.2021 respectively.

3.       Brief facts of the case, as emerged from the RP, Order of the State Commission, Order of the District Commission and other case records are that:-

(i)      Husband of Respondent No.1 herein obtained a Jeevan Mitra (Triple Cover Endowment Plan) policy on 15.01.2000 for  a sum assured of Rs.2,00,000/-.  Respondent No.1, who is the wife of the deceased, was the nominee of the deceased under the said policy.  Policy holder passed away on 16.06.2002, the Respondent being the legal heir submitted claim before the Petitioner, which was repudiated vide letter dated 19.12.2002 on the ground that deceased had suppressed material information regarding his health at the time of obtaining the policy.  Respondents filed consumer complaint No.191/2004 before the District Forum, which allowed the complaint by holding that the repudiation of the claim on the ground of suppression of material fact was not justified and directed the petitioner corporation to pay policy amount of Rs.2,00,000/- to the complainants alongwith interest @6%.  Petitioners herein filed Appeal before the State Commission vide No. A/1876/2005, which was dismissed on 05.03.2009.  Thereafter, Petitioners filed Revision Petition No. 3713/2009 before National Commission, which was also dismissed on 03.12.2009.  Accordingly, the Petitioner Corporation paid the amount along with costs etc.  to the complainant as awarded by the State Commission on 15.02.2010.  The said amount/cheque was accepted/received by the Respondent herein, hence, it is the case of the Petitioner that the order dated 29.05.2005 in CC No.191/2004 passed by the State Commission attained finality. 

ii)      The respondents herein again filed CC/142/2012 before the District Forum, which was dismissed vide order dated 12.03.2015, stating that the cause of action, accrued to the complainant for filing earlier complaint (consumer complaint No. 191/2004),  complainant has filed present complaint on the same cause of action and on the same subject matter before the Forum.  She had right to claim three time of the Policy amount, at the time of filing her earlier Complaint (consumer complaint No. 191/2004), before the forum, but she had claimed policy amount to the extent of Rs.2,00,000/- only and relinquished claim for balance amount and no reason whatsoever for abandoning such claim was mentioned by her. As per provisions of “Order-2, Rule-2”, she cannot claim balance Insurance amount, in this complaint, on the basis of same cause of action & and on the same subject matter, which she had given up earlier.

(iii)    Aggrieved by the said order dated 12.03.2015 of District Forum, Respondents herein filed an Appeal before State Commission vide No. A/267/2015.  The State Commission on 10.04.2019 allowed the Appeal and set aside the order dated 12.03.2015 of the District Forum directing the Petitioner herein to pay to the Respondent  “rest of the amount minus the amount of Rs.2,38,800/- paid by way of cheque (accepted under protest by the complainant) to get valid discharge for the insurance claim by paying the amount equivalent of sum assured under policy scheme (sum of Rs.6,00,000/-) + Bonus on the basic sum assured in the sum of Rs.2,00,000/- after deducting the amount already paid or deposited alongwith interest @9% p.a. on the earlier amount due and payable until final discharge is obtained by O.P. and a sum of Rs.10,000/- towards compensation for mental anguish and deficiency in service and Rs.10,000/- for cost of litigation.”

(iv)    Aggrieved by the above said order of the State Commission, Petitioner is before this Commission in the present Revision Petition. 

4.       Petitioner has challenged the said Order dated 10.04.2019 of the State Commission inter alia on following grounds:

1. The State Commission’s order suffers from grave infirmity and material illegality, State Commission order is perverse and State Commission has wrongly concluded that the second complaint would not be barred under Order 2 Rule 2 of Code of Civil Procedure, 1908.

2. It is settled preposition of law that all claims and causes of action must be pleaded as far as practicable and all matters between the parties be disposed of finally.  If it is not done, the law mandates that no case after case can be filed by splitting the claim to which person has a right.

3. The claim of the respondents in the second complaint is incorrect because it is based on a cause of action which was foundation of the former complaint in CC/191/2004, the State Commission erred in placing reliance on the judgment of this Commission in Goa Urban Cooperative Bank Ltd. Vs. Franklin Noronha and Anr. reported in 3 (2008) CPJ 12 NC.

(iv)    The complaint of Respondents is time barred.

5.       Heard counsels of both sides.  Contentions/pleas of the parties, on various issues raised in the RP, Written Arguments, and Oral Arguments advanced during the hearing, are summed up below.

6.       It is admitted by the Petitioner that the policy in question was a tripple benefit policy, under the provisions of which, although in normal situation on maturity of the policy period, only the sum assured, that is  Rs.2,00,000/-, was payable, in the situation of any event/mis-happening before the maturity date, three times the sum assured i.e. Rs.6,00,000/- was payable.  Initially the claim under the policy was repudiated on 19.12.2002 on the ground that deceased had suppressed material information regarding his health at the time of policy, hence, the claim was not admissible.  However, this repudiation was set aside through the Consumer Complaints from District Forum to National Commission through CC No. 191/2004, FA No. A/1876/2005 and RP/3713/2009 holding that repudiation of claim on the ground of suppression of material fact was not justified.  It was also admitted during the oral hearing that in normal situation where the claim under such policy is found admissible the nominee/legal heirs of the assured are entitled to three times of the sum assured under the policy i.e. Rs.6,00,000/-.  However, the same is contested by the Petitioner on account of legal grounds of second consumer complaint before the District Forum vide No. 142/2012  being barred on account of earlier CC/191/2004 having been decided on merits.  These grounds as well as the legal issues of the second CC being barred under Order 2 Rule 2 of CPC were also raised by the Petitioner before the State Commission and State Commission has appropriately dealt with these pleas/objections of the Petitioner at the stage of Appeal.  The Respondents/complainants have contended before the State Commission that they have accepted the amount/cheque under protest without prejudice to her rights even at the time when claim was to be discharged on behalf of the OP and furthermore under the provisions of Consumer Protection Act 1986 , second complaint is not barred when the entire claim due under the policy was not accepted.  The complainant relied upon the judgment of the National Commission in  Goa Urban Cooperative Bank Ltd. Vs. Franklin Noronha and Anr. reported in 3 (2008) CPJ 12 NC Page 31  and Vithal Ganpatrao Adhaoo and another Vs. Shrikisan Nanaji Kondalkar and Ors. reported in 2016 (1) Mh. L. J. page No.575.

7.       The State Commission in its impugned order has observed that the District Forum did consider the aforesaid principles in rulings before it under Order 2, Rule 2  CPC.  It opined that since the complainant has demanded relief for only principal amount of sum assured of Rs.2,00,000/-, she again claimed the relief for balance sum on the ground that her second complaint would not be barred under Order 2 Rule 2 of the CPC.  The State Commission had observed that the cheque was accepted by the complainant under protest without prejudice to her rights.  Regarding bar of limitation as canvassed by the Respondent, the State Commission observed that the time spent  in earlier proceedings has to be excluded . State Commission observed that reasons stated by District Forum for dismissal of complaint are unsustainable and unacceptable, and after considering the rulings cited before it and terms & conditions of the policy, particularly triple benefit under table No. 133-20 three times the sum assured plus bonus becomes payable.      

8.       The Petitioner herein has contended that the main relief sought by the Respondents herein in CC/191/2004 was as follows:-

“Direct the opposite party No.1 Life Insurance Corporation to pay the amount of the policy of Rs.2,00,000/- taken out by the late husband of the complainant in full along with interest, bonus, etc. accrued thereon, along with interest at the rate of 18% per annum from the date of filing of complaint till realization thereof, to the complainants…..”

9.       A perusal of the complaint dated 21.12.2004 in CC/191/2004 shows that the word Rs.200000/- was inserted subsequently by hand.  The initial wording stood as ‘to pay the amount of the policy taken out by late husband of the complainant’, It was also mentioned in the complaint that the wife of the deceased is illiterate and unemployed, it is natural for a nominee/legal heir of a deceased, who is not well-educated, to presume that the amount payable under the Policy is the sum assured and they may have found it later that it was Triple Benefit Policy and the amount payable is three times the sum assured in the situation of a death happening before maturity. 

10.     We are of the view that once it is/was decided that amount under the policy in question is payable, it is the duty of the Insurance Company to pay the entire amount payable as per terms and conditions of the policy, notwithstanding that nominee/Legal Heirs of such a policy, out of ignorance might have initially made a claim for lesser amount.  This is more so in the case of petitioner in the present case, which is a citizen-centric welfare oriented organization under the administrative control of Government of India.  It was held by Hon’ble Supreme Court in Canara Bank Vs. United India Insurance Co. Ltd. & Ors. (2020) 3 SCC 455 that “Insurance Policy must be read holistically so as to give effect to reasonable expectations of all the parties including the insured and the beneficiaries-  it must be interpreted in a commercially sensible manner- coverage clauses to be read broadly, and ambiguity, if any, to be resolved in favour of insured-exclusions to be read narrowly.”

11.     Hence, we are of the considered view that Petitioner being a public sector insurance company, should not shy away from fulfilling its obligations in full under the policy when it has been held by the State Commission that repudiation of claim by the Petitioner was not justified and the sum assured under the policy was held to be payable, rather than contesting the balance claim of respondents on technical grounds.  Hence, the State Commission, after considering all the pleas/grounds raised by the Petitioner herein, including that of claim being barred under Order 2 Rule 2, have concluded that reasons stated by District Forum for dismissal of complaint are unsustainable and after considering the rulings cited before it and terms & conditions of the policy, has held that triple benefit amount of the sum assured policy i.e. Rs.6.00 lakhs plus bonus is payable. 

12.     For the reasons stated hereinabove, and after giving a thoughtful consideration to the entire facts and circumstances of the case, various pleas raised by the learned Counsel for the Parties, we do not find any infirmity or material irregularity or jurisdictional error in the order of the State Commission.  As was held by the Hon’ble Supreme Court in Rubi Chandra Dutta Vs. United India Insurance Co. Ltd. [(2011) 11 SCC 269] that the scope in a Revision Petition is limited. Such powers can be exercised only if there is some prima facie jurisdictional error appearing in the impugned order. In Sunil Kumar Maity Vs. State Bank of India & Ors. [AIR (2022) SC 577]  held 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”. Accordingly, the RP is dismissed. The order dated 10.04.2019 of the State Commission is upheld.

13.     The pending IAs in the case, if any, also stand disposed off.