National Consumer Disputes Redressal
Tata Aig Life Insurance Co. Ltd. & Anr. vs Jhalu Roy & 4 Ors. on 25 March, 2019
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NEW DELHI REVISION PETITION NO. 1754 OF 2015 (Against the Order dated 20/03/2015 in Appeal No. 333/2014 of the State Commission West Bengal) 1. TATA AIG LIFE INSURANCE CO. LTD. & ANR. THROUGH BRANCH MANAGER, 1ST FLOOR,ANGAN BUILDING, 1/3K.K BANERJEE ROAD, P.O & P.S BERHAMPRE, DISTRICT : MURSHIDABAD - 742101 W.B. 2. TATA AIG LIFE INSURANCE CO LTD., THROUGH MANAGER, 6TH PENINSULA CORPORATE PARK, G.K MARG, LOWER PAREL WEST, MUMBAI - 400013 MAHARASHTRA ...........Petitioner(s) Versus 1. JHALU ROY & 4 ORS. S/O HARIPADALAL ROY, VILL.BHALIAPARA, P.O & P.S, BAGWANGOLA, DISTRICT : MURSHIDABAD W.B. 2. LALU ROY, S/O. LATE HARIPADALAL ROY VILL.BHALIAPARA, P.O & P.S, BAGWANGOLA, DISTRICT : MURSHIDABAD W.B. 3. BIRU ROY, S/O. LATE HARIPADALAL ROY, R/O VILL.BHALIAPARA, P.O & P.S, BAGWANGOLA, DISTRICT : MURSHIDABAD W.B. 4. LAKSHMIRANI ROY, W/O LATE HARIPADALAL ROY, R/O VILL.BHALIAPARA, P.O & P.S, BAGWANGOLA, DISTRICT : MURSHIDABAD W.B. 5. LAKSHMIRANI ROY, W/O LATE HARIPADALAL ROY, R/O VILL.BHALIAPARA, P.O & P.S, BAGWANGOLA, DISTRICT : MURSHIDABAD W.B 6. RINA PRASAD, W/O GAUTAM PRASAD, R/O VILL.BHALIAPARA, P.O & P.S, BAGWANGOLA, DISTRICT : MURSHIDABAD W.B 7. - - ...........Respondent(s)
BEFORE: HON'BLE MR. PREM NARAIN,PRESIDING MEMBER
For the Petitioner : Mr. Joydip Bhattacharya , Advocate For the Respondent : For the Respondent Nos.1 to 4: Ms. Aprajita Mukherjee, Advocate
For the Respondent No.5 : nemo
Dated : 25 Mar 2019 ORDER
This revision petition has been filed by the petitioners Tata AIG Life Insurance Co. Ltd. & Anr. against the order dated 20.3.2015 of the State Consumer Disputes Redressal Commission, West Bengal, ( in short 'the State Commission') passed in FA No.333/2014.
2. Brief facts of the case are that the deceased life assured (DLA) took one policy number No.UOI3903495 dated 08.07.2008 from the opposite party and another second Policy No. 166639881 was taken by the DLA on 23.09.2010. The life assured expired on 26.04.2011. The Insurance Company paid the claim of Rs.1,8,7500/- for the first policy, however, the claim in respect of the second policy was not fully paid and the value of units as Rs.36,735.87 was paid in respect of second policy by the respondent company. The respondent/complainant filed a consumer complaint before the District Consumer Disputes Redressal Forum, Berhampore Murshidabad (in short 'the District Forum') and the District Forum vide its order dated 09.01.2014 allowed the complaint as under:-
"That the consumer complaint No.40/2013 be and same is allowed on contest against the Opposite parties but the circumstance, without cost.
The Opposite Parties are directed to make it done individually and collectively so that the assured sum of Rs.5,00,000/- paid to the complaints within 45 days from this day failing which such amount would carry interest @10% p.a. from the date of filling of the case until full realization. Again the Opposite Parties are liable to pay Rs.25/- individually per day's delay as fine in default of non-compliance of the order within the time framed the amount to be accumulated shall be deposited in the State Consumer Welfare Fund."
3. Aggrieved with the order of the District Forum, the opposite parties preferred an appeal before the State Commission and the State Commission vide impugned order dated 20.3.2015 dismissed the appeal, however modified the order of the District Forum as under:-
"that the appeal be and the same is allowed in part on contest against the Respondents, but without any order as to cost. The Appellants are directed to pay a sum of Rs.5,00,000/- (minus the cheque amount of Rs.36,735.87, if encashed), to the Respondent No.4/Complainant No.4, i.e., the nominee, within 40 days from the date of this order i.d., they shall pay interest @9% over this amount from the date of this order till full and final payment. The impugned order is modified accordingly."
4. The petitioner Insurance Company has preferred the present revision petition against the order of the State Commission.
5. Heard both the learned counsel for the parties and perused the records.
6. Learned counsel for the petitioners stated that the DLA was suffering from various diseases like diabetes, ischemic heart disease and hypertension but he did not provide this information in the proposal form. The Insurance Company paid the claim under the first policy because that policy had continued for more than 2 years and as per Section 45 of the Insurance Act, 1938 this policy could not have been called into question. So far as second policy is concerned, it has run only for 10 months and, therefore, Insurance Company is entitled to raise questions in respect of this policy. The DLA has taken treatment of these diseases as an OPD patient and the investigator has submitted the OPD card in this regard which was filed along with written statement filed by the Insurance Company. Similarly another prescription of a private doctor has also been filed. Both these documents are sufficient to prove that the DLA was suffering from serious diseases and he had not provided this information in the proposal form. Hence, this is a clear case of concealment of material information and Insurance Company is authorised to repudiate the claim in this regard. As a gesture of goodwill Tata AIG Insurance Company, however, has paid the value of units under the policy amounting to Rs.36,735.37.
7. Learned counsel argued that the State Commission has rejected these documents on the ground that only the photocopies were submitted and no affidavit was filed by the investigator. It was stated by the learned counsel that this is a public document and does not require any authentication. The learned counsel referred to the judgment of this Commission passed in RP No.2130 of 2007, Life Insurance Corporation of India Vs. Smt. Surekha Shankar Jadhave & Ors., decided on 31.07.2012 (NC) wherein the following has been held:-
"This being the situation, it is settled law that when there is deliberate suppression of material fact pertaining to health on the part of the life assured, the contract of insurance which is based on principle of utmost good faith gets vitiated and the cause of death becomes irrelevant."
8. It was further argued by the learned counsel that the State Commission has observed that the rejection of claim under second policy is not justified because the Insurance Company has agreed to pay the insurance amount under the first policy. The learned counsel stated that this can be no ground as both the policies were taken at different times and the first policy was covered under Section 45 of the Insurance Act, whereas second policy was not covered under this Section. Based on these grounds the learned counsel requested that the revision petition may be allowed and the orders of the fora below may be set aside.
9. On the other hand, the learned counsel for the respondent/complainant stated that both the fora below have given concurrent finding to the effect that DLA was not suffering from any pre-exiting disease at the time of filling up of the proposal forms. The facts cannot be reassessed at the stage of revision petition as the scope under the revision petition is only limited to jurisdictional aspects.
10. It was further stated by the learned counsel for the respondents that the documents relating to OPD treatment of the DLA have not been approved either by the concerned hospital or by the investigator. Hence, State Commission has rightly not considered them. Learned counsel referred to the following cases in support of his arguments:-
(1) RP No.3653 of 2006, Life Insurance Corporation of India Vs. Smt. Charanjit Kaur, decided on 14.10.2011 (NC).
(2) RP No.1304 of 2014, M/s. ICICI Prudential Life Insurance Company Ltd. Vs. Mrs. Veena Sharma & Anr. decided on 05.11.2014 (NC).
11. I have given a thoughtful consideration to the arguments advanced by both the learned counsel and have examined the record. Fora below have not relied upon the OPD card and prescription slip of a private doctor based on the other evidence available on record. Moreover, these documents have not been verified and proved by the concerned doctor of the hospital or by the investigator. This Commission in LIC of India Vs. Joginder Kaur and Ors., RP No.2067 of 2001, decided on 23.09.2004 (NC) has observed the following:-
"11. No affidavit of any doctor who had treated him earlier was produced nor any other material piece of evidence had been produced to support the contention of the petitioner except opinions and inferences based on surmises. Even the investigation report has not been produced though the matter was not investigated. It is contended that record of Dayanand Medical Hospital wherefrom the deceased got the treatment and O.P.No.1 had collected death certificate, etc. has allegedly proved that the deceased was admitted on 16.8.1998 in Dayanand Medical Hospital. In this light, in absence of any evidence except filing the proposal form, etc. in the face of affidavits of Surinder Kaur, Inderjeet Kaur and Swaran Singh it is not possible to hold that the deceased was alcoholic. He got study award in his education. Simple allegations made by the petitioner that the deceased was alcoholic; was suffering from diabetes mellitus, and jaundice etc. would not be sufficient. The unproved case history recorded by some person on the date of admission of Sh. Bachan Singh, the deceased, would not be cogent and convincing evidence to repudiate the claim unless it was coupled with medical report for the treatment prior to submission of the proposal form. "
12. On the basis of the above judgment of this Commission, it seems that the State Commission has rightly rejected the claim of the Insurance Company based on these documents. Fora below have given concurrent finding so far as it relates to payment of the Insurance claim of Rs.5 lacs. The scope under the revision petition is quite limited against the concurrent finding given by fora below and the facts cannot be reassessed by this Commission as held by Hon'ble Supreme Court in Mrs. Rubi (Chandra) Dutta vs. United India Insurance Company, 2011 (3) Scale 654, wherein the following has been observed:-
"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 that 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 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 finding of two fora."
13. Based on the above discussion, I do not find any illegality material irregularity or jurisdictional error in the order dated 20.03.2015 passed by the State Commission in FA No.333 of 2014, which calls for any interference from this Commission.
...................... PREM NARAIN PRESIDING MEMBER