Chandigarh

StateCommission

A/48/2024

THE NEW INDIA ASSURANCE COMPANY LTD. - Complainant(s)

Versus

UPINDER KAUR - Opp.Party(s)

KRISHNA KANT

21 Nov 2024

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION,

U.T., CHANDIGARH

(Additional Bench)

==============

 

Appeal No.	:	A/48/2024
Date of Institution	:	01.02.2024
Date of Decision	:	21.11.2024

 

 

The Divisional Manager, New India Assurance Co. Ltd., SCO 58, Sector 26-C, Chandigarh.

 

Now through its authorized signatory – Vishal Malhotra, Assistant Manager (Legal), The New India Assurance Co. Ltd., Regional Office, SCO 36-37, Sector 17-A, Chandigarh.                                                                             

... Appellant

                                                         Versus

Upinder Kaur wife of Sh. Adarshvir Singh D/o Late Sh. Harinder Bir Singh, Resident of House No. 39, Phase 3-A, SAS Nagar, Mohali, Punab.

                                                                                               …Respondents

 

BEFORE:       MRS. PADMA PANDEY, PRESIDING MEMBER

                       MR.PREETINDER SINGH, MEMBER

 

Argued by:    Sh. Krishna Kant, Advocate for the Appellant.

                      Sh. Paras Money Goyal, Advocate for the Respondent.

PER PADMA PANDEY, PRESIDING MEMBER

 

1]                This appeal is directed against the order dated 27.12.2023, rendered by the District Consumer Disputes Redressal Commission-I, U.T. Chandigarh (hereinafter to be referred as “the Ld. District Commission”), vide which, it partly allowed the Consumer Complaint bearing no. 165 of 2020 in the following terms;

1. In view of the above discussion, the present consumer complaint succeeds and the same is accordingly allowed. OP is directed as under:-

 

1. to pay USD 6562 to the Complainant in Indian Currency prevailing at the time of filing of the claim with interest @9% P.A. from the date of repudiation of claim till onwards.

 

2. to pay Rs.20,000/- to the complainant as compensation for causing mental agony and harassment to him;

 

3. to pay Rs.10,000/- to the complainant as costs of litigation.

 

15.  

 

2]                For the convenience, the parties are being referred to, in the instant Appeal, as position held in Consumer Complaint before the Ld. District Commission.

3]                Before the Ld. District Commission, it was the case of the Complainant that the Policy Holder – Sh. Harinder Bir Singh (now deceased) the father of the complainant was having medi claim insurance policy (Business and Holidays)  of Opposite Party valid with effect from 09.09.2018 to 06.10.2018. The insured Harinder Bir Singh and his wife had a trip to USA from 09.09.2018 to 04.10.2018. During his stay in USA the insured Harinder Bir Singh suffered a cardiac arrest and died on 30.09.2018. In the process for repatriation of the mortal remains of the deceased/insured from California to New Delhi, postmortem and for air tickets and visa and other charges a total amount of 6562 USD were incurred. After mortal remains came back to India, the cremation was undertaken at Chandigarh. Eventually, the complainant lodged claim with the Opposite Party and completed all the documentary formalities. However, the Opposite Party vide email dated 06.02.2020 closed the claim of the complainant. Hence the aforesaid Consumer Complaint was filed before the Ld. District Commission, alleging deficiency in service and unfair trade practice on the part of the Opposite Party.

4]                In the reply filed before the Ld. District Commission, the Opposite Party in their written statement asserted that the claim of the complainant was repudiated due to non-disclosure of material facts by the insured Late Sh. Harinder Bir Singh at the time of taking the policy.  It was pleaded that the insured Hardinder Bir Singh was having a past history of diabetes and said fact intentionally has never been disclosed in the proposal form.  The insured was also treated for hyperglycemia and having history of diabetes and as such, the claim was denied and the said fact was intimated to the son of the insured and he was advised to submit the medical reports from Washington Hospital mentioning that the insured does not have history of diabetes which he could not submit. Thus the claim of the complainant was rejected on account of pre-existing disease condition. Denying all other allegation and pleading no deficiency in service, the Opposite Party prayed for dismissal of the complaint.

5]                On appraisal of the pleadings of the parties and evidence adduced on record, Ld. District Commission partly allowed the Consumer Complaint of the complainant as noticed in the opening para of this order.

6]                Aggrieved against the aforesaid order passed by the Ld. District Commission, the instant Appeal has been filed by the Appellant/ Opposite Party.

7]                We have heard the Learned Counsel for the parties and have gone through the evidence and record of the case with utmost care.

8]                The core question that falls for consideration before this Commission is as to whether the Ld. District Commission has rightly passed the impugned order by appreciating the entire material placed before it.          

9]                After giving our thoughtful consideration, to the contentions raised and material on record, we are of the considered opinion, that the instant Appeal is liable to be dismissed for the reasons to be recorded hereinafter.    

10]               It is the case of the Appellant that the Ld. District Commission while passing the impugned order has failed to appreciate the documentary evidence available on record, which resulted into perverse finding. Also, the impugned order was passed without taking into consideration the facts of the case and without appreciating the correct legal position, which resulted into gross miscarriage of justice and thus deserves to be set aside. The learned counsel further argued on the similar lines and prayed for acceptance of the present appeal.

11]               Conversely, it has been contended on behalf of the Respondent that the order passed by the Ld. District Commission is quite just & right and does not call for any interference. The detailed finding of facts has already been recorded by the District Commission while rejecting the stand of the Appellant. The learned counsel further argued on the similar lines as stated in the complaint filed before the Ld. District Commission and prayed for dismissal of the present appeal. 

12]               The main thread which runs through the present controversy is whether the insured had not disclosed about his diabetic history and was guilty of suppression of material facts.

13]               Admittedly, the insured/deceased died during the currency of the subject policy. Learned Counsel for the Appellant argued that the insured/ deceased was having a past history of diabetes and the said fact was intentionally concealed in the proposal form and the said act & conduct amount to non-disclosure and concealment of material facts. The Ld. District Commission failed to appreciate the fact that the insured/ deceased was treated for hyperglycemia and was having history of diabetes and therefore, the claim was rightly denied by the OP/Appellant as per the terms and conditions of insurance policy. However, we do not find any merit in the same, in as much as, before issuing the policy the Appellant (Insurance Company) got the insured medically examined by the doctor appointed by the Appellant itself and if there would have been anything wrong or objectionable with the reports the Appellant would not have issued the policy on the first place. Also, nowhere in their written version the Appellant has raised objection qua the said medical examination of the insured.  Moreover, no documents pertaining to any past history of the policy holder i.e. prior to issuance of policy has been appended before the Ld. District Commission. Even the Ld. District Commission in Para No. 11 of the order impugned before us has categorically held that “……….it shows contradictory stand taken by the OP as on the one hand it says that the complainant was suffering from diabetic condition on the other hand as per Annexure C-2 all reports and medical certificates of the complainant were duly checked by the OP before issuing the policy in question”. Also, while take due note of the inpatient record/detail summary of the health status of the insured issued by the Washington Hospital Healthcare System, the Ld. District Commission has recorded a categorical finding to the effect that there is no evidence and document on record from which it could be conclude as alleged by the OP-Insurance Company and the act of the OP-Insurance Company tantamounts to deficiency in service and unfair trade practice. As such, the argument raised by the Learned Counsel for the Appellant regarding non-disclosure and concealment of material fact is declined.

14]               Learned Counsel for the Appellant further argued that the Ld. District Commission failed to appreciate the fact that per terms & condition of insurance policy, the Respondent has not placed on record any document to show that they have notified the W.T.A. regarding the medical condition of the insured prior to lodging the claim with the OP/Appellant.  Record shows, the Appellant never during the case management process objected on any proof with reference to any information provided to WTA neither the same was a ground for repudiation of the claim. Also, the said objection was never taken by the Appellant in their written version before the Ld. District Commission. Furthermore, under the terms & conditions under head ‘covered expenses’, it is clearly mentioned that in extreme emergency in remote areas where WTA cannot be contacted, the medical evacuation must be reported to the first available physician. Pertinently, per averments made in Para No.6 of the consumer complaint, the Complainant has categorically mentioned that immediately after the medical problem of the insured came to light and it necessitated to be consulted with a medial practitioner, the said doctor and the hospital were informed regarding the medi-claim policy and they in turn lodged a claim with the insurance company and as such no amount was charged from the wife of the deceased policy holder. Hence, the argument raised by the Learned Counsel with reference to information provided to WTA is also declined. Thus, to our mind, no case is therefore made for any interference in the well reasoned findings recorded by the Ld. Lower Commission.

15]               No other point was urged, by the Learned Counsel for the parties.

16]               It is demonstrable from a reading of the impugned Order of the Ld. District Commission that it is certainly not an order passed without reasons or without applying the judicious mind. The facts and circumstances of the case have been gone into, weighed and considered, and due analysis of the same has been made. It also does not appear to be an order passed without taking into account the available evidence.

17]               In the wake of the position, as sketched out above, we are dissuaded to interfere with the impugned order rendered by the Ld. District Commission. The appeal being bereft of merit is accordingly dismissed and the order of the Ld. District Commission is upheld.

18]               All the pending application(s), if any, also stands disposed off accordingly.

19]               Certified Copies of this order, be sent to the parties, free of charge. 

20]               The file be consigned to Record Room, after completion and the Ld. District Commission be sent back immediately.

Pronounced

21^st Nov. 2024

                                                                                                                             

Sd/- [PADMA PANDEY]

PRESIDING MEMBER

Sd/- [PREETINDER SINGH] MEMBER

 

“Dutt”