ORIENTAL INSURANCE COMPANY LTD.versusMUNIMAHESH PATEL

                                                                                 -'
 A                       ORIENTAL INSURANCE COMPANY LTD.
                                            v.
                                 MUNIMAHESHPATEL



 B
                                 SEPTEMBER 12, 2006

              [ARIJIT PASA YAT AND LOKESHWAR SINGH PANTA, JJ.]                             -
            Insurance:

            Insurance policy-Death of insured-Claim refused by Insurance
 C Company on the ground offalse statem7nt-Complaint before State Consumer
      Disputes Redressal Commission-Held, as complainant raised dispute about
      genuineness of documents produced by Insurance Company, and the factual
      position was required to be established by documents, matter should be
      examined by appropriate court of law and not by the Commission.                  '
 D          Proceedings before-Consumer Disputes Redressal Commission--Held,
      are essentially summary in nature--Adj:1dication of issues which involve
      disputed factual questions should be examined by appropriate court of law
      and not by the Commission.

, E         Wife of the complainant-respondent obtained a Jana ta Personal Accident
      Policy for a sum of Rs.5 lakhs. She fell into a well and died. The respondent
      claimed payment, but when the claim was not settled by the Insurance
      Company, the respondent filed a complaint before the State Consumer
      disputes Redressal Commission which dismissed the complaint leaving the
      complainant to take appropriate proceedings for establishing his claim in a
 F    court of competent jurisdiction. The complainant filed an appeal before the
      National Consumer Disputes Redressal Commission, which allowed the claim.
      Aggrieved, the Insurance Company filed the present appeal.

            It was contended for the appellant that the complainant was not entitled
 G    to any relief as he was guilty of making false statement in the proposal form.
      It was submitted that in a copy of the proposal form it was mentioned that
      respondent's wife, the insured, was a teacher, whereas in the actual copy of
      another form it was mentioned that she was a housewife.

           Allowing the appeal, the Court

 H                                          30
           ORIENTALINSURANCECOMPANYLTD. v. MUNIMAHESHPATEL[PASAYAT,J.)          3J

            HELD: Proceedings before the Commission are essentially summary           A
     in nature and adjudication of issues which involve disputed factual questions
     should not be adjudicated. Complainant raised dispute about genuineness of
     the documents (i.e. proposal forms) produced by the appellant. The factual
     position was required to be established by documents. Commission was
     required to examine whether in view of the 1disputed facts it would exercise     B
     the jurisdiction. The Commission having accepted that there was wrong
     declaration of the nature of occupation of the person insured, should not have
     granted the relief in the manner done. The State Commission was right in
     its view that the complex factual position requires that the matter should be
     examined by an appropriate Court of Law and not by the Commission.
                                                                          [33-8-F)    C
           CIVIL APPELLATE JURISDICTION : Civil Appeal No. 490 I of2006.

~·        From the Judgment and Order 19.5.2004 of the National Consumer
     Disputes Redressal Commissions, New Delhi in F.A. No. 82 of 2002.
                                                                                      D
           Vishnu Mehra and B.K. Satija for the Appellant.

          Sandeep S. Tiwari, Yogendra Kumar Dwivedi and D.N. Mishra for the
     Respondent.

           The Judgment of the Court was delivered by
                                                                                      E
           ARIJIT PASA YAT, J. Leave granted.

            Appellant calls in question legality of the judgment rendered by the
     National Consumer Disputes Redressal Commission, New Delhi (in short the
     'Commission'). The Commission upset the order of the State Commission and        F
     held that the appellant was liable to pay to the respondent (hereinafter
     referred to as the 'complainant') a sum of Rs.5 lakhs together with interest
     @ 6% p.a. from the date of the complaint.

          Factual position in a nutshell is essentially as follows:
                                                                                      G
           Smt. Lalitha Devi Patel wife of the complainant had obtained a Janata
     Personal Accident Policy for a sum of Rs.5 lakhs in August, 1998, for which
     a premium was paid and accepted and the policy was issued. The insured died
     on account of an accident by way of falling into a well and drowning. FIR
     was lodged, autopsy was performed and appellant was informed. Various
     documents were also furnished claiming payment in spite of the policy. When      H
    32                         SUPREME COURT REPORTS [2006] SUPP. 6 S.C.R.

A the appellant-Company did not settle the claim, a complaint came to be filed
    before the Madhya Pradesh State Consumer Redressal Commission, Bhopal
    (in short 'the State Commission') alleging deficiency in service on the part of
    the appellant. State Commission after hearing the parties dismissed the
    complaint leaving the complainant to take appropriate proce~ding for
    establishing his claim and for seeking the reliefs in the court of competent
                                                                                      .. .
B   jurisdiction. Aggrieved by this order. appeal was filed before the Commission.

        After hearing the parties, the Commission passed order dated 2.5.2002
  allowing the complaint and setting aside the order of the State Commission.
  Since this order had been passed ex-parte against respondent, on an
C application moved by the respondent the earlier order was recalled and both
  the parties were given opportunity to present their case. It directed payment
  of the amount as noted above.

           The Commission accepted that there was no dispute regarding
    genuineness of the policy. But it noted that there was dispute about disclosure
D   made in the proposal form and the information given. It accepted that she
    was not employed as stated in the proposal fonn. Commission did not
    consider it necessary to go into that question and held that though there may
    _have been some information given which has no relation with the actual state
    of affairs, yet the factum of the accident resulting in death and policy was
    not in dispute and, therefore, the claim of the complainant was to be allowed.
E
           In support of the appeal, learned counsel for the appellant submitted
    that the principle of good faith which is inherent in insurance was not there.
    The complainant was guilty of making false statement in the proposal form.

          Learned counsel for the appellant has brought on record a copy of the
F proposal fonn in which it is mentioned that the respondent's wife i.e. the
  insured was a teacher. This is at variance with the actual copy of another form
  has also been produced and shows that the respondent accepted that she
  was a house wife. The State Commission, therefore, dismissed the appeal in
  view of the disputed factual position and directed the complainant-respondent
G to seek remedy, if any, available in any other appropriate forum. Learned
  counsel for the appellant further submitted that when there is suppression of
  material fact which is relevant to the coverage of policy, the respondent was
  not entitled to any relief and the Commission had accepted that she was not
  a teacher. He, therefore, contended that the respondent was not entitled to
  any relief.
H
         ORIENTALINSURANCECOMPANYLTD. r. MUNIMAHESHPATEL[PASAYAT.J.]         33
          Learned counsel for the respondent on the other hand submitted that      A
   no interference is called with the decision of the Commission. He also stated
   that tio such proposal form as claimed by the appellant was submitted.

          The Commission noted that the specific stand of the appellant was that
   there was mis-declaration in the proposal form and the false claim that the     B
   respondent's wife was a teacher which as now appears is not the correct
   position. It also accepted that she was really not a teacher.

            Proceedings before the Commission are essentially summary in nature
      and adjudication of issues which involve disputed factual questions should
      not be adjudicated. It is to be noted that Commission accepted that insured C
 .... was not a teacher. Complainant raised dispute about genuineness of the
/ documents (i.e. proposal forms) produced by the appellant.

         The Commission having accepted that there was wrong declaration of
  the nature of occupation of the person insured, should not have granted the
  relief in the manner done.                                                       D
         The nature of the proceedings before the Commission as noted above,
   are essentially in summary nature. The factual position was required to. be
  established by documents. Commission was required to examine whether in
  view of the disputed facts it would exercise the jurisdiction. The State
  Commission was right in its view that the complex factual position requires
                                                                                   E
  that the matter should be examined by an appropriate Court of Law and not
  by the Commission.

        Above being the position, the Commission was not justified to deal
  with the matter in the manner as was done. In our view, the directions of the    F
  State Commission were more appropriate keeping in line with the nature of
  dispute. Accordingly, the appeal is allowed but with no order as to costs.

  R.P.                                                        Appeal allowed.