NCDRC

NCDRC

RP/122/2021

ICICI PRUDENTIAL LIFE INSURANCE CO. LTD. & ANR. - Complainant(s)

Versus

R. SATHYANARAYANA - Opp.Party(s)

MR. SACHIN DAGA, RAKESH KANDARI, H.SHINDE & ANUPAMA SINGH

23 Aug 2023

ORDER

NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION
NEW DELHI
 
REVISION PETITION NO. 122 OF 2021
(Against the Order dated 13/08/2019 in Appeal No. 714/2016 of the State Commission Karnataka)
1. ICICI PRUDENTIAL LIFE INSURANCE CO. LTD. & ANR.
...........Petitioner(s)
Versus 
1. R. SATHYANARAYANA
...........Respondent(s)

BEFORE: 
 HON'BLE DR. INDER JIT SINGH,PRESIDING MEMBER

FOR THE PETITIONER :
MR. RAHUL, ADVOCATE
FOR THE RESPONDENT :
NEMO

Dated : 23 August 2023
ORDER

1.       None appears for the Respondent.  Respondent was absent on earlier dates also i.e. 04.07.2023,  12.01.2023, 16.12.2022, 23.06.2022, 31.03.2022 Accordingly, Respondent is proceeded ex parte.

 

2.       The present Revision Petition ( RP) has been filed by the Petitioners against the Respondent, as detailed above, under section 58 (1) (b) of the Consumer Protection Act 2019, against the order dated 13.08.2019 of the State Consumer Disputes Redressal Commission  Karnataka ( hereinafter referred to as the ‘State Commission’) in First Appeal ( FA) No. 714 of 2016 in which order dated 19.11.2015 of  District Consumer Disputes Redressal Forum Shanthinagar, Bangalore  (hereinafter referred to as District Forum)  in    Consumer Complaint  (CC) No. 1286 of  2014 was challenged, inter alia praying for setting aside the order dated 13.08.2019 and 19.11.2015 of the State Commission and District Forum respectively.

 

3.       Petitioners have challenged the said order dated 13.08.2019 of the State Commission  inter alia on the following grounds :

 

(a)      The Petitioner Company is willing to revoke the rejection and accept the claim permissible under the Policy.

(b)     Since policy in question is of fixed benefit type and not of re-imbursement type, the policy holder is entitled to receive fixed amount as per the treatment undergone.

( c)     Since Respondent has opted for Plan A of the policy and underwent surgery which is listed under Grade 5 of list of surgeries, the amount payable for the said surgery is Rs.75,000/- as per the terms and conditions of the policy and respondent is entitled to additional Rs.3000/- being the daily hospitalization, cash benefit, which brings the total amount payable to the respondent to Rs.78,000/-.

( d)    This Commission in the matter of Jyoti Rungta Vs. ICICI Prudential Life Insurance Co. Ltd. RP No. 628 of 2014 upheld the award of Rs.3000/- against the claim amount of Rs.71,218/-.

(e )     The Fora Below have arbitrarily awarded an amount of  Rs.2,31,835/- to the respondent for the alleged expenses incurred by him.

 

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(f)      Insurance policy is a contract by nature and the words of the same are to be strictly construed and while interpreting the meaning of the words of an insurance policy, the courts should ensure that benefits are payable only in accordance to the words of the contract.  Reliance is made on the following judgments of the Supreme Court

 

(i)      United India Insurance Co. Ltd. Vs. Harchand Rai Chandanlal 1 ( 2003) CPJ 393,

 

(ii)     Vikram Greentech ( I) Ltd. & Anr. Vs. New India Assurance Co. Ltd. II ( 2009) CPJ 34

 

(iii)    Export Credit Guarantee Corporation of India Ltd. Vs. Garg Sons International ( 2013) ( I) Scale 410

 

4.       Heard counsel for the Petitioner.  We have carefully gone through the orders of the State Commission as well as District Forum.  Both the Fora below have given a concurrent findings on the admissibility of claim of Rs.2,31,835/-.  The contention of the Petitioner about non disclosure of earlier ailment of back pain has been rejected by both the Fora below.  The State Commission took note of the contention of the Petitioner that even if the claim is accepted, complainant is eligible for Rs.78,000/- only under the policy but did not agree with the same.  Same contentions have been reiterated by the Petitioner before us in the RP. 

 

5.       We do not find merit in the contention of the Petitioner.  The State Commission and District Forum have given a well reasoned order and we do not find any reason to interfere with the same.  No law point(s) have been raised.   As was held by the Hon’ble Supreme Court in Rubi Chandra Dutta Vs. United India Insurance Co. Ltd. [(2011) 11 SCC 269],  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], the Hon’ble Supreme Court  held that “the revisional jurisdiction of the National Commission under Section 21(b) of the said Act is extremely limited. It should

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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.”  

 

6.       We find no illegality or material irregularity or jurisdictional error in the order of State Commission.  Hence, we uphold the order of the State Commission.  Accordingly, Revision Petition is dismissed.  Parties to bear their respective costs.

 

7.       If the Respondent / Complainant has already received any amount in pursuant to the order of the District Forum / State Commission, same shall be adjusted while paying the amount payable as per the order of the State Commission.  

 
................................................
DR. INDER JIT SINGH
PRESIDING MEMBER

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