NCDRC

NCDRC

RP/656/2020

BAJAJ ALLIANZ LIFE INSURANCE CO. LTD. - Complainant(s)

Versus

SK. MD. SAMIULLAH - Opp.Party(s)

MS. SHWETA PARIHAR & AMOL CHITALE

16 Feb 2024

ORDER

NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION
NEW DELHI
 
REVISION PETITION NO. 656 OF 2020
(Against the Order dated 03/12/2019 in Appeal No. 385/2017 of the State Commission West Bengal)
1. BAJAJ ALLIANZ LIFE INSURANCE CO. LTD.
...........Petitioner(s)
Versus 
1. SK. MD. SAMIULLAH
...........Respondent(s)

BEFORE: 
 HON'BLE AVM J. RAJENDRA, AVSM VSM (Retd.),PRESIDING MEMBER

FOR THE PETITIONER :
FOR THE PETITIONER : MS.SHWETA SINGH PARIHAR, ADVOCATE
FOR THE RESPONDENT :
FOR THE RESPONDENT : MD. ISRAR KHAN, ADVOCATE

Dated : 16 February 2024
ORDER

1.      The present Revision Petition has been filed by the Petitioner against impugned order dated 03.12.2019, passed by the learned State Consumer Disputes Redressal Commission, West Bengal, (‘the State Commission’) in First Appeal No. A/385/2017 wherein the State Commission partly allowed the Appeal filed by the Petitioner/OP and modified the order dated 05.01.2017 passed by the learned District Consumer Disputes Redressal Forum, Midnapore, (‘the District Forum’) and directed the Petitioner/OP to pay Rs.1,26,000/- as compensation for life of the deceased along with Rs.3,000/- as litigation cost to the Respondent/Complainant, within 45 days from the date of passing of the order failing which simple interest @9% p.a. shall accrue to the compensation amount of Rs.1,26,000/- from the date of default till the entire amount is fully realized.

 

2.      There is a delay of 140 days in filing the Revision Petition.  In the facts and circumstances of the case, the delay is condoned.

 

3.      For convenience, the parties are referred to as placed in the original Complaint filed before the District Forum.

 

4.      Brief facts of the case, as per the Complainant, are that the Complainant filed the death claim of the policy of his father (deceased life insured) DLI, after his death on 30.12.2015 for Rs.1,26,000/-.  However, the OP repudiated the claim vide letter dated 21.03.2016 on the grounds non-disclosure of treatments taken.  Being aggrieved, he filed a complaint before the learned District Forum seeking directions to OP to pay the claim amount of Rs.1,26,000/- along with interest @12% and Rs. 10000/- as compensation on account of mental harassment and Rs.5,000/- as litigation cost.

5.      In reply, the Petitioner/OP admitted the issuance of policy and receipt of the claim and contended that, while taking the policy, the deceased life insured (DLI) had hidden certain material information about his disease and treatment and deliberately and intentionally did not disclose the facts of his ailment. This amounted to suppression of material fact and giving misstatement with ulterior intention to obtain the insurance policy. The OP came to know during investigation that the deceased life insured was admitted in the Uluberia S.D. Hospital, Ulberia, Howrah from 25.12.2015 to 30.12.2015. The DLI died in the said hospital on 30.12.2015. However, he did not disclose the said fact while filling up the proposal form on 28.12.2015. Hence, the OP rightly repudiated the claim for non-disclosure of the material facts in the proposal form of the policy. The decision to repudiate the claim was taken in good faith and based on an inquiry. This being a considered repudiation, no deficiency is involved.

 

6.      The learned District Forum vide Order dated 05.01.2017 allowed the complaint and granted the following relief:-

“The OPs are directed to pay Rs.1,26,000/- to the within one month from the date of this order failing which the OP will be liable to pay interest at the rate of 9% per annum from the date of filing of the complaint till final payment. The OPs are also directed to pay Rs.3000/- as litigation cost to the complainant within one month from the date of this order, in default the OPs will be liable to pay Rs.50/- per diem as punitive charge which would be payable to Consumer Welfare Fund.”

 

7.      Being aggrieved by the Order of the learned District Forum, the Respondent/OP filed First Appeal No. A/385/2017 before the learned State Commission and the State Commission vide order dated 03.12.2019 allowed the Appeal in part and modified the order of the District Forum dated 05.01.2017 with the following observations:

“We have perused the papers on record and considered submissions of the Ld. Advocate appearing on behalf of the Appellant/OP.

 

  The papers revealed that the policy was initiated on 29/12/2015 and the patient died of myocardial infarction on 30/12/2015. Running page 67, being the "Death Certification” confirmed the Respondent/ Complainant’s stay in the Hospital for a period of 6 days w.e.f. 25.12.2015 till his death on 30/12/2015.  Further, the letter dated 12/07/2016 issued by the Appellant/OP Insurance Company to the Ld.Advocate on behalf of the Respondent/Complainant on 28/12/2015 gave false declaration about the state of his health suppressing the fact his having certain disease.  It was peculiar to note that the very date 28.12.2015 on which the deceased had allegedly given wrong information deliberately about his state of health, fell within the period of his hospitalization.

 

  We are afraid, we are unable to consider any suppression of the disease as the Agent of the Insurance Company collected information from the insured during the period of his hospitalization when the deceased's suffering was witnessed by he himself.

 

  Seeing that the patient was hospitalized, the agent should not have initiated the process for issuing the policy or should have got the patient examined medically by the company panelled doctors. Astonishingly, the said Agent of the Appellant/OP company initiated the process and issued the policy with utmost promptitude admittedly receiving from the deceased the policy premium to the tune of Rs. 12,480/-. This led us to assume that the agent was satisfied with the health condition of the insured.

 

  We did not have any paper supporting the fact of the deceased having any knowledge about the disease allegedly pre existed with him. Naturally, since the deadline of his period of survival was not known to him, the patient might have unknowingly and innocently recorded the state of his health condition. Since the Appellant/OP Company failed to discharge miserably his onus to substantiate his allegation, we were left with reasons to consider that the disease allegedly pre- existed with the deceased insured was not conclusively proved. More so, when the Insurance Company, being the Principal, cannot rule out his responsibility and liability for the work done by its agent.

 

  We, in view of the above, do not indulge in any view contradictory to the District Forum's observation of allowing the Complaint. As regards providing relief to the Respondent/ Complainant, we are not in agreement with the direction of payment of the punitive charges @ Rs. 50/-per diem to be paid by the Appellant/OP in case of default of payment of cost within the specified period of one month and intend to expunge that part of the order.

 

  Hence, ordered that the Appeal be and the same stands allowed in part. The Appellant/OP is hereby directed to pay Rs. 1,26,000/-as compensation for life of the deceased to the Respondent/Complainant as the nominee of the deceased.

 

  He is also directed to pay a litigation cost of Rs. 3,000/- to the Respondent/Complainant. In the given situation, we are not in favour of passing any order for payment of compensation.

 

  Entire decretal amount has to be paid within 45 days from the date of passing of the instant order, failing which, simple interest @ 9% p.a. shall accrue to the compensation amount of Rs. 1,26,000/-from the date of default till the entire amount is fully realized.

 

  The impugned Judgment and Order stands modified accordingly.

 

 

8.      Being dissatisfied by the Impugned Order dated 03.12.2019 passed by the State Commission, the Petitioner / Complainant has filed the instant Revision Petition bearing no.656 of 2020.

9.      I have examined the pleadings and other associated documents placed on record, including the orders of both the learned for a, and rendered thoughtful attention to the arguments advanced by the learned Counsels for both the parties.

 

10.    The contentions and arguments of Petitioner/OP are centred on the assertion that the claim was rightly repudiated due to non-disclosure of material facts pertaining to his medical condition at the time of taking the insurance policy by the DLI. The learned Counsel for the Petitioner/OP relied on certain legal precedents to assert that the proposer has a duty to disclose pre-existing ailments health condition to the insurer and she relied upon the following judgments in support of her arguments:

(i) General Assurance Society Limited Vs. Chandumull Jain & Anr., AIR 1966 SC 1644;

 

(ii) The Oriental Insurance Co. Ltd. Vs. Sony Cheriyan, (1999) 6 SCC 451;

 

(iii) Grasim Industries Ltd Vs Aggarwal Steel,(2010)1SCC 83;

 

(iv) Bajaj Allianz Life Insurance Co. Ltd. Vs. Dalbir Kaur, (2020) SCC Online SC 848;

 

(v) Reliance Life Insurance Co. Ltd. & Anr. Vs. Rekhaben Nareshbhai Rathod, (2019) 6 SCC 175;

 

(vi) V. Kishan Rao Vs. Nikhil Super Speciality Hospital & Anr. Reported in (2010) 5 SCC 513.

 

11.    On the other hand, the case of the Respondent/Complainant revolves around the rejection of a death claim under a life insurance policy. The Respondent, who is the nominee of the deceased policyholder, contended that the claim was wrongfully repudiated by the insurance company. The Respondent asserted that the deceased Insured never concealed any material facts. The Petitioner sought to upheld the concurrent findings of both the Fora and dismiss the Revision Petition with cost.

 

12.    It is a matter of record that the deceased had obtained a life insurance policy and the Complainant filed the death claim of the policy of his father (deceased life insured) DLI, after his death on 30.12.2015 claiming Rs.1,26,000/-. However, the Petitioner/OP repudiated the claim vide letter dated 21.03.2016 for failing to disclose the medical treatments as required. Hence, the Respondent/ Complainant filed complaint seeking directions to the Petitioner/OP to pay Rs.1,26,000/- along with compensation. It is also an admitted position that the insured was admitted in Uluberia S.D. Hospital, Ulberia, Howrah from 25.12.2015 to 30.12.2015. The insured died on 30.12.2015 in the said hospital. The Petitioner/Insurance Company relied upon the document of “Death Certificate” wherein it has been mentioned that the insured was admitted in the said hospital during the said period. It is also not disputed that the proposal form was filled by the Agent of the Insurance Company in the Hospital on 28.12.2015 and signed by the insured on the same date. Therefore, the details of the insured was collected by the Agent of the Insurance Company himself from the site during the period of his hospitalization and the deceased’s suffering was witnessed by him personally. In normal course, in addition to this, the insurer also usually gets the proposer medically examined, before the decision on issue of policy is taken. Therefore, there is no question of any suppression of pre-existing disease, since no other document has been produced by the Petitioner/ OP to independently establish any suppression of pre-existing diseases suffered by the deceased life insured.

 

13.    The learned District Forum issued a detailed order based on evidence and arguments advanced before it. The learned State Commission, after due consideration of the pleadings and arguments, determined that no intervention is warranted on the District Forum's order except some modifications to the tune of quantum of compensation and passed a well-reasoned order.

 

14.    It is a well settled position in law that the scope for Revision under Section 21(b) of the Consumer Protection Act, 1986 and now under Section 58(1)(b) of the Act, 2019 confers very limited scope and jurisdiction on this Commission. In the present case, there are concurrent findings of the facts and the revisional jurisdiction of this Commission is very limited. After due consideration of the entire fact and material on record, I do not find any illegality, material irregularity or jurisdictional error in the impugned Order passed by the learned State Commission warranting interference in revisional jurisdiction under the Act. I place reliance on the decision of the Hon’ble Supreme Court in the case of ‘Rubi (Chandra) Dutta Vs. M/s United India Insurance Co. Ltd., (2011) 11 SCC 269. Further, in ‘Sunil Kumar Maity vs. SBI & Anr.  Civil Appeal No. 432 of 2022 Order dated 21.01.2022 the Hon’ble Supreme Court held as follows:-

“9. It is needless to say 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. In the instant case, the National Commission itself had exceeded its revisional jurisdiction by calling for the report from the respondent-bank and solely relying upon such report, had come to the conclusion that the two fora below had erred in not undertaking the requisite in-depth appraisal of the case that was required. .....”

15.    Similarly, in a recent order the Hon'ble Supreme Court in Rajiv Shukla Vs. Gold Rush Sales and Services Ltd. (2022) 9 SCC 31 has held that:- 

As per Section 21(b) the National Commission shall have jurisdiction to call for the records and pass appropriate orders in any consumer dispute which is pending before or has been decided by any State Commission where it appears to the National Commission that such State Commission has exercised its jurisdiction not vested in it by law, or has failed to exercise a jurisdiction so vested, or has acted in the exercise of its jurisdiction illegally or with material irregularity. Thus, the powers of the National Commission are very limited. Only in a case where it is found that the State Commission has exercised its jurisdiction not vested in it by law, or has failed to exercise the jurisdiction so vested illegally or with material irregularity, the National Commission would be justified in exercising the revisional jurisdiction. In exercising of revisional jurisdiction the National Commission has no jurisdiction to interfere with the concurrent findings recorded by the District Forum and the State Commission which are on appreciation of evidence on record.

 

16.    Based on the deliberations above, I do not find any merit in the present Revision Petition and the same is, therefore, Dismissed. Simultaneously, the Petitioner/OP is also directed to pay an simple interest @ 9% per annum on the claim amount of Rs.1,26,000/- from the date of repudiation of the claim, i.e. 21.03.2016, within four weeks failing which the Petitioner/OP shall be liable to pay further interest @12% per annum for such extended period. The Petitioner/OP is at liberty to recover the amount of the claim from the Agent who facilitated the issue of the policy in question, in accordance with law.

 

17.    Keeping in view the facts and circumstances of the present case, there shall be no order as to costs.

18.    All pending Applications are also disposed of accordingly.

 
...................................................................................
AVM J. RAJENDRA, AVSM VSM (Retd.)
PRESIDING MEMBER

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