This revision petition has been filed by the petitioner Reliance Nippon Life Insurance Co Ltd. against the order dated 29.06.2018 of the State Consumer Disputes Redressal Commission, Maharashtra (in short ‘the State Commission’) passed in FA No.937 of 2017.

2.      Brief facts of the case are that the husband of the complainant had taken a Golden years Plan Plus type of policy from the respondent by paying Rs.15,000/- as premium on 08.09.2008.  Sum assured under the policy was Rs.2,50,000/-.  In case of accident, the complainant is eligible to receive Rs.2,50,000/- as sum assured and another Rs.2,50,000/- towards double benefit of accidental death, totalling Rs.5 lacs.  On 08.08.2009, complainant’s husband died due to snake bite.  Opposite party was informed about the incident.  On 23.10.2009, opposite party repudiated the claim of the complainant wherein the following has been mentioned:-

“On investigation and from medical documents, we understand that late Mr. Patil Gajanan Kashinath, was hospitalised during August 2008 and was diagnosed for Pulmonary Koch. Late Mr. Patil Gajanan Kashinath was advised to continue anit-TB treatment.

Late Patil gajanan Kashinath, submitted proposal for insurance on 08/09/2008 the relevant questions in the proposal form and answers provided by him are reproduced below:

Question 29: ‘Are you currently taking any medication or drugs, other than minor conditions, (eg cold and flue), either prescribed by a doctor, or have you suffered from any illness, disorder, disability or injury during the past 5 years which has required any form of medical or specialized examination (including chest x rays, gynaecological investigations, pap smear or blood tests), consultants, hospitalization or surgery?’

Answer: No

Question 30: ‘Do you suffer from any medical ailments, eg diabetes, high blood pressure, cancer, respiratory disease, kidney or liver disease, stroke, any blood disorder, heart problems, Hepatitis B or C, Tuberculosis, psychiatric disorder, depression, HIV/AIDS or a related infection?’

Answer: No

The non disclosure of Hospitalisation & Pulmoany Disease was material to the issuance of the policy and ought to have been disclosed in the proposal form.  By not doing so, the Proponent had misled us to grant his insurance cover on the terms as stated in the policy schedule. 

In the light of the above facts and the irrefutable evidence we hold that we were provided with false and inaccurate answers, we are constrained to repudiate the claim under the policy in terms of Section 45 of the Insurance Act, 1938.  According to our policy conditions, all claim benefit shall cease and all monies that have been paid will be forfeited to us.  But as a good will gesture, we are pleased to inform you that the fund balance of Rs.13456.59 is being paid.  Our branch officials will personally hand over the cheque to you.”

3.      Aggrieved, the complainant filed a consumer complaint bearing No.91/2010 before the District Consumer Disputes Redressal Forum, Jalgaon (in short ‘the District Forum’).  The complaint was resisted by the opposite party on the same ground on which the repudiation was made.  However, the District Forum vide its order dated 08.06.2015 allowed the complaint and directed the opposite party Insurance Company to pay Rs.5,00,000/- to the complainant along with 9% interest from the date of repudiation till actual payment along with Rs.5,000/- as compensation for mental agony and Rs.2000/- for cost of litigation. 

4.      Aggrieved by the order of the District Forum, the Insurance Company preferred an appeal before the State Commission.  The State Commission vide its order dated 29.06.2018 dismissed the appeal on the ground of limitation.

5.      Hence, the present revision petition by the petitioner Insurance Company. 

6.      Heard the learned counsel for the petitioner at the admission stage.

7.      Learned counsel for the petitioner stated that the State Commission has dismissed the appeal on the ground of limitation.  The learned counsel stated that the original delay in filing the appeal was 80 days.  However, the delay increased to about 500 days due to the fact that the appellant was directed to file the appeal before the Circuit Bench at Aurangabad as the cause of action was at Jalgaon. When the appeal was filed before Aurangabad Bench, it was advised that the same may be filed before the Nasik Bench.  Then the appeal was filed at the Nasik Bench of State Commission.  Thus, there has been no fault of the appellant Insurance Company and the delay has only been caused due to circumstances mentioned. The learned counsel argued that the State Commission should have appreciated this fact and should have condoned the delay in the interest of merits of the case. 

8.      Coming to the merit of the case, the learned counsel stated that the Deceased Life Assured (DLA) had suppressed the material information in the proposal form as mentioned in the repudiation letter. The DLA was suffering from the disease tuberculosis and he was hospitalised in August 2008 and was also diagnosed as suffering from pulmonary koch and he was advised to continue anti tuberculosis treatment.  The proposal form was filled on 08.09.2008.  Thus, clearly the DLA was suffering from tuberculosis and was receiving treatment for tuberculosis, however, this information was not disclosed by the DLA in the proposal form.  Thus, there was a suppression of material information by the insured and therefore, the insurance claim was rightly repudiated. 

9.      It was further argued that the District Forum and the State Commission have relied upon the post-mortem report wherein it is mentioned that the death occurred due to snake bite.  The fora below have taken a view that in the light of the post-mortem report and in the light of the cause of death as ‘snake bite’ the suppression of the material fact does not really matter.  Based on this view, both the fora below have accepted the Insurance claim of the complainant.  Learned counsel mentioned that suppression of material information itself is sufficient to repudiate the claim and the cause of death is not important so far as the suppression of material fact is proved.  In this regard, the learned counsel relied upon the judgment of   the Hon’ble Supreme Court in Satwant Kaur Sandhu Vs. New India Assurance Co. Ltd., 2009 INDLAW SC 856, wherein the following has been held:-

“[A]  Insurance- Material fact- Meaning of –Term “material fact” is not defined in Act- In general terms it means as any fact which would influence judgment of a prudent insurer in fixing premium or determining whether he would like to accept risk- Held, in a Contract of Insurance, any fact which would influence mind of a prudent insurer in deciding whether to accept or not to accept risk is a “material fact”- Appeal dismissed.   

[C]   Consumer Protection- Insurance- Mediclaim policy- Repudiation of –Mis-representation and suppression of material facts regarding health made by policy holder-Non-disclosure of fact in proposal form at time of taking out mediclaim policy, that policy holder was suffering from chronic Diabetes and Renal failure fact- Whether factum of said illness was a “material” fact for purpose of a mediclaim policy and its non-disclosure was tantamount to suppression of material facts enabling Insurance Company to repudiate its liability under policy?- Mediclaim is a contract of insurance falling in category of contract uberrimae fidei, meaning a contract of utmost good faith on part of assured- When an information on a specific aspect is asked for in proposal form, an assured is under a solemn obligation to make a true and full disclosure of information on subject which is within his knowledge-Any inaccurate answer will entitle insurer to repudiate his liability because there is clear presumption that any information sought for in proposal form is material for purpose of entering into a Contract of Insurance- Held, statement made by insured in proposal form as to state of his health was palpably untrue to his knowledge-  There was clear suppression of material facts in regard to health of insured and, therefore, respondent-insurer was fully justified in repudiating insurance contract- Appeal dismissed.” 

10.    I have given a thoughtful consideration to the arguments advanced by the learned counsel for the petitioner and examined the record.  It is admitted by the learned counsel that initially there was a delay of 80 days in filing the appeal before the State Commission though it increased to 500 days due to filing of appeals at different Benches of the State Commission for which definitely the petitioner is not responsible. However, there is no explanation for the initial 80 days delay in filing the present appeal.  Clearly, this delay is on account of usual procedural delays in obtaining the inter-departmental advice and in obtaining the higher orders.  Clearly such delays are not considered to be sufficient cause for condoning the delay in filing the appeals or revisions.  Special periods of limitation have been prescribed under the Consumer Protection Act 1986, its Rules 1987 and its Regulations 2005 so that the consumer disputes are decided within a reasonable time as held by the Hon’ble Supreme Court in Anshul Aggarwal vs. New Okhla Industrial Development Authority, IV (2011) CPJ 63 (SC) as under:-

“It is also apposite to observe that while deciding an application filed in such cases for condonation of delay, the Court has to keep in mind that the special period of limitation has been prescribed under the Consumer Protection Act, 1986 for filing appeals and revisions in consumer matters and the object of expeditious adjudication of the consumer disputes will get defeated if this Court was to entertain highly belated petitions filed against the orders of the consumer Foras.”

11.   Decision of Anshul Aggarwal (Supra) has been reiterated in CicilyKallarackalVs. Vehicle Factory, IV (2012) CPJ 1(SC) 1, wherein Hon’ble Supreme Court observed;

“4. This Court in Anshul Aggarwal v. NOIDA, (2011) CPJ 63 (SC) has explained the scope of condonation of delay in a matter where the special Courts/ Tribunals have been constituted in order to provide expeditious remedies to the person aggrieved and Consumer Protection Act, 1986 is one of them. Therefore, this Court held that while dealing with the application for condonation of delay in such cases the Court must keep in mind the special period of limitation prescribed under the statute (s).

  5.    In the instant case, condoning such an inordinate delay without any sufficient cause would amount to substituting the period of limitation by this Court in place of the period prescribed by the Legislature for filing the special leave petition. Therefore, we do not see any cogent reason to condone the delay.         

6.      Hence, in the facts and circumstance of the case as explained hereinabove, we are not inclined to entertain these petitions. The same are dismissed on the ground of delay.”

12.    In R.B. Ramlingam Vs. R.B. Bhavaneshwari, 2009 (2) Scale 108, Hon’ble Supreme Court observed:-

“We hold that in each and every case the Court has to examine whether delay in filing the special appeal leave petitions stands properly explained. This is the basic test which needs to be applied. The true guide is whether the petitioner has acted with reasonable diligence in the prosecution of his appeal/petition”.

13.    The above quoted authoritative judgments of the Hon’ble Supreme Court are fully applicable in the facts and circumstances of the present case and even if the time spent at different benches of the State Commission is ignored, there is a substantive delay of 80 days in filing the appeal.  Thus, clearly appeal before the State Commission was barred by limitation. 

14.    Even if one ignores the delay in filing the appeal before the State Commission and consider the case on merits, it is seen that the insured has died due to snake bite which is also considered as an accident.  Post-mortem has confirmed the death due to snake bite. Hon’ble Supreme Court in Sulbha Prakash Motegaonkar And Ors. Vs. Life Insurance Corporation of India, Civil Appeal No.8245 of 2015, decided on 05.10.2015 (SC) has held the following:-

“We have heard learned counsel for the parties.

        It is not the case of the Insurance Company that the ailment that the deceased was suffering from was a life threatening disease which could or did cause the death of the insured.  In fact, the clear case is that the deceased died due to ischaemic heart disease and also because of myocardial infarction.  The concealment of lumbar spondylitis with PID with sciatica persuaded the respondent not to grant the insurance claim.

        We are of the opinion that National Commission was in error in denying to the appellants the insurance claim and accepting the repudiation of the claim by the respondent.  The death of the insured due to ischaemic heart disease and myocardial infarction had nothing to do with this lumbar spondylitis with PID with sciatica.  In our considered opinion, since the alleged concealment was not of such a nature as would disentitle the deceased from getting his life insured, the repudiation of the claim was incorrect and not justified.”

15.    On the basis of the above observations of the Hon’ble Supreme Court, it is clear that if the cause of death is not related to the alleged pre-existing disease, then the suppression of information in respect of pre-existing disease will not be as material so as to disentitle the insured from the insurance claim completely. 

16.    It is seen that the judgment of Hon’ble Supreme Court in Satwant Kaur Sandhu Vs. New India Assurance Co. Ltd., (supra) is in respect of mediclaim policy, whereas the instant case is of accidental death.  The recent liberal view of the Hon’ble Supreme Court is reflected in Sulbha Prakash Motegaonkar And Ors. Vs. Life Insurance Corporation of India, (supra) and hence I am inclined to rely on the judgment of Hon’ble Supreme Court in Sulbha Prakash Motegaonkar And Ors. Vs. Life Insurance Corporation of India, (supra).  Accordingly, the complainant is entitled to accidental death benefit claim under the policy.

17.    Based on the above discussion, I do not find any merit in the revision petition, which calls for any interference from this Commission and therefore, the revision petition No.2418 of 2018 is dismissed at the admission stage.