1.     Although advocates have abstained from attending the Commission today but Mr.Chawla, learned Counsel for the Petitioner, insists that he should be heard and his attendance be marked.  Accordingly, the matter is being heard.

2.     The present Revision Petition is filed against the order dated 19.9.2019 in Appeal No.1473/2014 filed by the Petitioner against the order of the District Forum dated 30.10.2014 in Additional Case No.92/2013. 

3.     The brief facts of the case are that the deceased Naginbhai Haribhai Chauhan wanted to construct a house and for that purpose, he had taken a home loan from State Bank of India.  The bank had approved the home loan to him and thereafter the Master Policy No.93000001306, Membership No.133119699 was issued by the Petitioner w.e.f. 16.2.2011 for the period of repayment of the loan, which was 144 months.  Under this policy, the Petitioner had assured that in case the insured, Naginbhai Haribhai Chauhan, dies during the pendency of repayment of the loan amount, i.e. period of 144 months, the balance loan amount shall be repaid by the Petitioner.  Unfortunately, the insured expired on 17.7.2012.  A claim along with the relevant papers was sent to the Petitioner but the Petitioner repudiated the claim on the ground that the insured had concealed his diseases at the time of taking the policy and that he was suffering from and was undergoing treatment for Diabetes Mellitus and Cirrhosis of Liver.  Thereafter the Complaint was filed.  The plea taken by

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the Petitioner before the District Forum was that since the deceased had given a wrong declaration and so he had violated the terms and conditions of the Policy and hence, the repudiation was justified and the petitioner was not liable to reimburse the balance loan amount.  Parties led their respective evidences before the District Forum.  After perusing the evidences on record and hearing the arguments of the learned Counsel for the parties, the District Forum reached to the conclusion that the Petitioner had not produced any positive evidence to prove that the terms and conditions were explained to the Complainant at the time of giving the Policy and therefore, those terms and conditions were not binding on the deceased.  The District Forum has also considered the arguments of the Petitioner that the insured was suffering from Diabetes Mellitus and Cirrhosis of Liver but did not disclose it and concluded that the Insurance Company had not produced the proposal form and since they had not produced the proposal form, it was difficult to ascertain whether in the proposal form the insured had concealed his diseases and concluded that the Petitioner had failed to prove its defence.  It also concluded that the Petitioner had not examined any doctor to prove that the insured was suffering from any such diseases.  After so concluding, the District Forum allowed the Complaint.

4.     In the Appeal against the order of the District Forum, the same pleas were taken by the Petitioner.  It was also submitted that the insured had signed the declaration form, thereby declaring he was in sound state of mind and physical health and was not suffering from Diabetes Mellitus and Cirrhosis of Liver diseases.  The Petitioner had also relied upon the treatment record of the insured in Surat General Hospital and Sadhana Kutir Hospital and the certificate of Surat General Hospital to

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prove that the deceased was admitted in the hospital on 17.1.2010 and diagnosed with Diabetes Mellitus and Cirrhosis of Liver.  The State Commission also considered the arguments and the plea of the Petitioner that the insured deceased was admitted in Ashutosh Hospital during the period from 10.5.2012 to 4.7.2012 for treatment of Cirrhosis of Liver and Diabetes Mellitus and duration of these diseases was reported to be three years.  The State Commission duly considered all these arguments and perused these records on which the Petitioner had relied and confirmed the findings of the District Forum that there was deficiency in service on the part of the Petitioner by repudiating the claim and has held as under :

“6. We have gone through the record, the appellant has mainly contended on the ground of pre-existing diseases and suppression of material facts and on that basis, the Insurance Company has repudiated the claim.  We have also gone through the proposal form which is available on record on page no.113 to 116 in which it has been shown that the terms and conditions had already been explained to the insured in Hindi language.

7. The contention taken by the Insurance Company is that the complainant was not in sound physical health and suffered from Diabetes Mellitus and Cirrhosis of Liver prior to the date of signing the membership form.

Insurance Company has submitted the medical report of Ashutosh Hospital in which it was shown that the DLA was admitted in hospital during 10.05.2012 to 04.07.2012 for the treatment of Cirrhosis of Liver and Diabetes Mellitus.  Moreover, the Insurance Company has submitted case papers of Surat General Hospital and Sadhana Kutir Hospital which also shows that the DLA was suffering from and was under treatment of Diabetes Mellitus and Cirrhosis of Liver.

The case papers of all three hospitals i.e. Surat General Hospital, Sadhana Kutir Hospital and Ashutosh Hospital pointed out the health condition of DLA and hence prima facie it seems that the DLA has suppressed his health condition in proposal form.

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However, learned District Forum has observed that the Insurance Company has not produced any affidavit of treating doctor.  Hence in the considered opinion of this Commission without affidavit of the treating doctors, medical papers submitted by the Insurance Company cannot be taken as an evidence.

8. Learned advocate Mr.Shah draw our attention to the page nos. 101 and 108 in which sum assured amount is shown as ₹7,13,558/- at inception and sum assured as on each month i.e. for the period from 16.7.2012 to 15.8.2012 is ₹6,71,430/-.  Hence in the opinion of this Commission, the outstanding loan as on the date of death of the insured member was ₹6,71,430/- only.

9. In view of the discussion above and looking to the facts of the case, in the opinion of this Commission, order of the learned District Forum required to be modified and if Insurance Company pay a lump sum amount ₹5,00,000/- as a claim amount to the complainant instead of ₹7,50,000/- then it would be just and proper amount in this case.  Hence, following final order is passed.”

5.     In the present Revision Petition, the same pleas have been raised before us by the Petitioner, which had been taken before the District Forum and the State Commission on which there are concurrent findings of facts.  Both the District Forum and the State Commission had reached to the conclusion after going through all the documents that the medical papers have not been properly proved since neither the doctor has been duly examined nor his affidavit has been furnished and hence the Petitioner had failed to prove its defence. 

6.     It is settled proposition of law that the jurisdiction of this Commission under Section 21(b) is very limited.  This Commission is not expected and required to re-appreciate and re-assess the evidences and reach to a different conclusion on facts inasmuch as the findings of facts are perverse.  Where on the basis of evidences the fora below have reached to a conclusion, which is a possible conclusion, then such

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conclusion need not be disturbed in the Revision Petition.  Hon’ble Supreme Court in “Rubi (Chandra) Dutta Vs. United India Insurance Co. Ltd. – (2011) 11 SCC 269”, as under:

“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”.

 7.    These findings are reiterated by Hon’ble Supreme Court in “Lourdes Society Snehanjali Girls Hostel and Ors. Vs. H&R Johnson (India) Ltd. and others, (2016) 8 Supreme Court Cases 286,” the Hon’ble Supreme Court has reiterated the same principle and has held as under:

“17.    The National Commission has to exercise the jurisdiction vested in it only if the State Commission or the District Forum has either failed to exercise their jurisdiction or exercised when the same was not vested in them or exceeded their jurisdiction by acting illegally or with material irregularity.  In the instant case, the National Commission has certainly exceeded its jurisdiction by setting aside the concurrent finding of fact recorded in the order passed by the State Commission which is based upon valid and cogent reasons.”

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8.     Therefore, this Commission cannot re-appreciate the evidences and after re-assessing those cases disturb the findings of facts which is a possible conclusion.  We do not find any illegality in the impugned order.  Present Revision Petition has no merits and is dismissed.  No order as to costs.