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2017 DIGILAW 417 (HP)

Birla Sun Life Ins. v. Pradeep Kumar Gupta

2017-04-26

MEENA VERMA, P.S.RANA, VIJAY PAL KHACHI

body2017
JUDGMENT P.S. Rana(R) President —Present appeal is filed under section 15 of Consumer Protection Act 1986 against order passed by learned District Forum Shimla in consumer complaint No. 397/2011 title Pradeep Kumar Gupta v. M/s. Birla Sun Life Insurance Company Limited & Anr. decided on 08.04.2016 . Brief facts of Case: 2. Complainant Pradeep Kumar filed complaint under section 12 of Consumer Protection Act 1986 before learned District Forum pleaded therein that opposite party No.1 is providing life insurance services. It is pleaded that complainant as per persuasion of agent of opposite parties was insured and obtained Mediclaim policy. It is pleaded that insurance-cum-investment cover was issued by complainant on 14.10.2006. It is further pleaded that complainant paid first premium to the tune of Rs. 25000/- (Twenty five thousand). It is pleaded that premium was payable annually upto 2020 and it is further pleaded that insurance policy was to remain in force for a period of 25 years. It is pleaded that complainant was to be provided medical insurance to the tune of Rs. 2,10,000/- (Two lac ten thousand) per year. It is further pleaded that opposite parties were under legal obligation to indemnify insured in the case of accidental death M/s. Birla Sun Life Insurance Company Limited & Anr. v. Pradeep Kumar Gupta (F.A. No. 262/2016) and critical illness. It is pleaded that in the month of June 2011 complainant was diagnosed to be suffering from coronary artery disease at Fortis Hospital at Mohalli. It is further pleaded that complainant was advised surgery. It is pleaded that complainant was hospitalized w.e.f. 24.06.2011 to 26.06.2011. It is further pleaded that complainant in the month of July 2011 preferred claim before opposite parties relating to amount spent on medical treatment. It is further pleaded that complainants submitted bills of treatment and discharge summary. It is further pleaded that on 29.07.2011 complainant received letter from opposite parties annexure A-7 stating therein that claim was not payable because treatment which the complainant had undergone was excluded in policy. Complainant sought following reliefs:- Relief of payment of Rs. 2,10,000/- (Two lac ten thousand) along with interest @12% per annum w.e.f. July 2011 till the date of payment. In addition complainant also sought damages to the tune of Rs. 30,000/- (Thirty thousand). In addition complainant also sought litigation costs to the tune of Rs. 10,000/- (Ten thousand). 3. Complainant sought following reliefs:- Relief of payment of Rs. 2,10,000/- (Two lac ten thousand) along with interest @12% per annum w.e.f. July 2011 till the date of payment. In addition complainant also sought damages to the tune of Rs. 30,000/- (Thirty thousand). In addition complainant also sought litigation costs to the tune of Rs. 10,000/- (Ten thousand). 3. Per contra version filed on behalf of opposite parties pleaded therein that opposite parties did not commit any deficiency in service. It is pleaded that complainant was suffering from coronary artery disease and same was not included under the insurance policy. It is pleaded that claim M/s. Birla Sun Life Insurance Company Limited & Anr. v. Pradeep Kumar Gupta (F.A. No. 262/2016) of complainant was repudiated strictly in accordance with law. Opposite parties sought compensatory costs to the tune of Rs. 50,000/- (Fifty thousand) from complainant. It is further pleaded that at the time of issuing insurance policy all terms and conditions of insurance policy were explained to complainant. Prayer for dismissal of complaint sought. 4. Learned District Forum allowed the complaint filed by complainant and ordered opposite parties to pay a sum of Rs. 2,10,000/- (Two lacs ten thousand) to the complainant along with interest @ 9% per annum from the date of filing of complaint till the date of actual payment. Learned District Forum also ordered opposite parties to pay Rs. 10,000/- (Ten thousand) to complainant on account of mental harassment. Learned District Forum further ordered opposite parties to pay litigation costs to complainant to the tune of Rs. 5000/- (Five thousand) within 45 days. 5. Feeling aggrieved against order passed by Learned District Forum opposite parties filed present appeal before State Commission. 6. At the time of final hearing none appeared on behalf of respondent and as the proceedings under Consumer Protection Act 1986 are time-bound proceedings State Consumer Commission decided to dispose of appeal on merits. State Commission heard learned advocate appearing on behalf of appellants and perused entire record carefully. M/s Birla Sun Life Insurance Company Limited & Anr. v. Pradeep Kumar Gupta (F.A. No. 262/2016) . 7. Following points arises for determination in present appeal. 1. State Commission heard learned advocate appearing on behalf of appellants and perused entire record carefully. M/s Birla Sun Life Insurance Company Limited & Anr. v. Pradeep Kumar Gupta (F.A. No. 262/2016) . 7. Following points arises for determination in present appeal. 1. Whether former affidavit filed in support of complaint (Pleadings) can be treated as evidence on affidavit under section 13(4)(iii) of Consumer Protection Act 1986 qua controversial facts for adjudication finally and whether reception of evidence on affidavits under section 13(4)(iii) of Consumer Protection Act 1986 are essential on the principles of natural justice and ends of justice. 2. Final order. Findings upon point No. 1 with reasons: 8. Complainant did not file any affidavit relating to proof of controversial facts as required under section 13(4) (iii) of Consumer Protection Act 1986. Learned advocate who appeared on behalf of complainant before District Forum has given statement on dated 20.11.2013 that affidavit filed along with complaint and annexures A-1 to A-9 be read as complainant''s evidence for adjudication of controversial facts. Complainant also did not adduce any rebuttal evidence before learned District Forum despite seven opportunities granted by learned District Forum to complainant to adduce rebuttal evidence. 9. Opposite parties filed affidavit of Mr. Amber Gupta authorised representative. There is recital in affidavit that opposite parties deny and dispute all facts mentioned in complaint against opposite parties. There is recital in affidavit that all terms and conditions of insurance policy were M/s. Birla Sun Life Insurance Company Limited & Anr. v. Pradeep Kumar Gupta (F.A. No. 262/2016) discussed with complainant and thereafter complainant opted to obtain medical insurance plan and signed the proposal form There is further recital in affidavit that complainant was suffering from coronary artery disease. There is further recital in affidavit that coronary artery disease is excluded from insurance policy. 10. Complaint is defined under section 2(c) of Consumer Protection Act 1986. As per section 2(c) of Consumer Protection Act 1986 complaint means any allegation in writing made by complainant. It is held that affidavit filed along with complaint is relating to pleadings only. It is held that complaint is pleadings of parties and not evidence of parties under section 13(4)(iii) of Consumer Protection Act 1986 qua controversial facts. It is held that pleading of parties and evidence of parties upon controversial facts are two different concepts under law. It is held that affidavit filed along with complaint is relating to pleadings only. It is held that complaint is pleadings of parties and not evidence of parties under section 13(4)(iii) of Consumer Protection Act 1986 qua controversial facts. It is held that pleading of parties and evidence of parties upon controversial facts are two different concepts under law. As per law there are two types of controversy inter se parties i.e. controversy of facts and controversy of laws. It is held that Consumer Forum directed parties to adduce evidence relating to controversial facts when opposite parties deny or dispute allegations contained in complaint. In the present case opposite parties have denied and disputed allegations contained in complaint in version. It is held that learned District Forum after perusal of contents of complaint and after perusal of version of opposite parties directed complainant to adduce evidence in M/s. Birla Sun Life Insurance Company Limited & Anr. v. Pradeep Kumar Gupta (F.A. No. 262/2016) proof of controversial facts under section 13(4)(iii) of Consumer Protection Act 1986. It is held that complainant did not file any fresh affidavit relating to controversial facts under section 13(4)(iii) of Consumer Protection Act 1986 but simply relied upon affidavit filed earlier along with complaint (Pleadings). 11. It is held that learned District Forum has committed procedural material irregularity by way of admitting former affidavit filed in support of complaint (Pleadings) as evidence of controversial facts under section 13(4)(iii) of Consumer Protection Act 1986. State Commission has perused affidavit filed in support of complaint. There is no recital in former affidavit that affidavit was filed in evidence of controversial facts under section 13(4) (iii) of Consumer Protection Act 1986. On the contrary there is recital in former affidavit that former affidavit was filed in support of complaint (Pleadings) only. State Commission is of the opinion that it is not expedient in the ends of justice to dispose of appeal on merits until procedural material irregularity is not rectified by learned District Forum. State Commission is of opinion that reception of evidence on fresh affidavits under section 13 (4)(iii) of Consumer Protection Act 1986 qua controversial facts are essential on the principle of natural justice and in the ends of justice in order to adjudicate complaint properly M/s. Birla Sun Life Insurance Company Limited & Anr. State Commission is of opinion that reception of evidence on fresh affidavits under section 13 (4)(iii) of Consumer Protection Act 1986 qua controversial facts are essential on the principle of natural justice and in the ends of justice in order to adjudicate complaint properly M/s. Birla Sun Life Insurance Company Limited & Anr. v. Pradeep Kumar Gupta (F.A. No. 262/2016) and effectively and to impart substantial justice inter se parties. It is well settled law that proceedings under Consumer Protection Act 1986 are quasi-judicial proceedings. Point No. 1 is decided accordingly. Point No. 2 : Final Order 12. In view of findings upon point No. 1 order dated 08.04.20 16 passed by learned District Forum is set aside and complaint is remanded to learned District Forum Shimla to obtain evidence of complainant by way of affidavits as per section 13(4)(iii) of Consumer Protection Act 1986 relating to controversial facts inter se parties. Learned District Forum will also give opportunity to opposite parties to adduce rebuttal evidence byway affidavit upon controversial facts under section 13(4)(iii) of Consumer Protection Act 1986. Learned District Forum will dispose of complaint afresh within three months. Observations will not effect merits of the case in any manner. Parties are directed to appear before learned District Forum Shimla on 09.05.2017. Parties are left to bear their own costs before State Commission. File of learned District Forum along with certified copy of order be sent back forthwith and file of State Commission be consigned to record room after due completion forthwith. Certified copy of order be transmitted to parties free of costs M/s. Birla Sun Life Insurance Company Limited & Anr. v. Pradeep Kumar Gupta (F.A. No. 262/2016) forthwith strictly as per rules. Appeal is disposed of. Pending application(s) if any also disposed of.