NCDRC

NCDRC

RP/1386/2018

RELIGARE HEALTH INSURANCE CO. LTD. & ANR. - Complainant(s)

Versus

SHIVRAM MEENA - Opp.Party(s)

M/S. SUMAN BAGGA & ASSOCIATES

08 May 2019

ORDER

NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION
NEW DELHI
 
REVISION PETITION NO. 1386 OF 2018
 
(Against the Order dated 03/04/2018 in Appeal No. 1009/2017 of the State Commission Rajasthan)
1. RELIGARE HEALTH INSURANCE CO. LTD. & ANR.
7TH FLOOR, TRIMURTI VIJAY CITI POINT ASHOK MARG, AHINSA CIRCLE, C-SCHEME
JAIPUR
RAJASTHAN
2. RELIGARE HEALTH INSURANCE CO. LTD.
D3, DISTRICT CENTRE SAKET,
NEW DELHI-110017
3. RELIGARE HEALTH INSURANCE CO. LTD.
D3, DISTRICT CENTRE SAKET,
NEW DELHI-110017
...........Petitioner(s)
Versus 
1. SHIVRAM MEENA
S/O. PANCHURAM MEENA R/O. RANDA WALI DHANI, CHAK KALIKHAAD POST THUMDI, TEHSIL NANGAL RAJAVATAAN
DISTRICT-DAUSA
RAJASTHAN
...........Respondent(s)

BEFORE: 
 HON'BLE MRS. JUSTICE DEEPA SHARMA,PRESIDING MEMBER
 HON'BLE MR. C. VISWANATH,MEMBER

For the Petitioner :
Mr. Suman Bagga, Advocate
For the Respondent :
Ms. Archna Pathak Dave, Advocate
Mr. Kumar Prashant, Advocate

Dated : 08 May 2019
ORDER

          The present revision petition has been filed against the order of the State Commission dated 3.4.2018 in appeal No.1009/2017 of the petitioner against the order of the District Forum dated 5.7.2017 whereby the claim of the respondent was allowed.

2.       The brief facts of the case are that the complainant purchased a personal accident policy and during the validity of the said policy he met with an accident on 4.1.2006 and he lost his one eye and he was issued permanent disability certificate by Medical & Health Department, Government of Rajasthan. On the basis of this certificate, he filed a claim with the petitioner. The petitioner repudiated the claim on the ground that it was a fraudulent claim.  The respondent thereafter filed a complaint. The written version was filed by the petitioner wherein they took up the plea that the claim was fraudulent as there is overwriting on the disability certificate and the year 2015 is changed to 2016. They also alleged that they had applied through RTI for the information and they were given a list which does not contain the name of the respondent. Hence, the claim was fraudulent. Parties led their evidences and after going through the evidences of the parties and the documents on record and hearing the arguments of the counsels for the parties, the District Forum reached to the conclusion that the claim was not fraudulent and awarded a sum of Rs.5 lakhs alongwith interest @ 12% towards the policy claim. It also awarded Rs.1 lakh towards compensation, Rs.10,000/- for mental agony and Rs.4,000/- towards litigation cost and 9% interest. The said order was impugned by the petitioner before the State Commission in appeal, in which impugned order has been passed.

          The only contention of the petitioner was that the permanent disability certificate was forged one and hence the claim was not payable. After hearing the arguments of learned counsel for the parties and perusing the original record of the case, the State Commission held as under: -

          “There is no dispute about the fact that the respondent has rest his claim on the permanent disability certificate No.60 dated 2.5.2016.

          The contention of the appellant is that the certificate is forged one and there is over writing on the date. The bare perusal of the certificate goes to show that at one place there is over writing on the date and year but at two places date is clearly written as 2.5.2016.

          The other contention of the appellant is that investigator has received the information under the Right to Information Act wherein the disability certificate has not been entered into the relevant register, hence, it may be presumed to be forged one. The investigator has asked the copy of the register from    District Medical Officer, District Hospital, Dausa whereas the certificate has been issued by the Medical Board under the Disability Act, 1995 and the investigator has not tried to investigate the matter from the concerned doctors who were members of the medical board and furthermore the copy of the certificate has not been asked for under the Disability Act. In the light of the above it can very well be concluded that the investigate the matter at the right place and furthermore no affidavit of the investigator has been submitted in support of the report and the Forum below has right held so.

          In view of the above, there is no merit in this appeal and liable to be dismissed.”

 

 

This order is impugned before us by the Insurance Company on the same allegation that the permanent disability certificate is forged one. Our attention is drawn to certain documents and it is argued that as per these documents the claim is forged one. The learned counsel has urged us to re-appreciate and re-assess the evidences led before the District Forum and then reach to a conclusion on the fact whether the disability certificate was forged one or not. This Commission under Section 21 (b) of the Consumer Protection Act, 1986 has limited jurisdiction. It is not required to re-assess or re-appreciate the evidence and reach to its own independent conclusion., Hon’ble Supreme Court in Mrs. Rubi (Chandra) Dutta Vs. M/s United India Insurance Co. Ltd. 2011 (3) Scale 654  has held as under:

“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.”

 

          In view of the fact that there is concurrent finding on the facts whether the disability certificate was a forged one or not, we are not supposed to re-appreciate and re-assess the evidence and substitute our opinion. In view of the concurrent finding of the fact that the disability certificate submitted by the respondent while putting up his claim before the petitioner was not a forged document, we found no illegality or infirmity in the impugned order. The revision petition has no merits. The same is dismissed.

 
......................J
DEEPA SHARMA
PRESIDING MEMBER
......................
C. VISWANATH
MEMBER

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