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  • Op-1 Shri N.K. Sahu/Op-2 Shri R.K.Bhawnani
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Smart Summary

Summary of Opinion — Consumer Complaint No. CC/2020/13

Factual and Procedural Background

This opinion concerns Consumer Complaint No. CC/2020/13 titled "Smt. Tuleshwari Sahu Vs. Uco Bank & Anr." The record indicates the complaint file reference and key dates recorded on the face of the opinion: registration / initial record reference appears dated 17-03-2020, a court or registry date appears as 01-12-2022, and the matter was pronounced on 05-12-2022. The dispute arises from an insurance-related claim and the medical evidence surrounding that claim; the opinion records a chronology of medical events, hospital admissions, expert/medical board findings and the parties' contentions about entitlement to insurance proceeds. The case file contains medical and claim documents, references to amounts and to alleged payments/adjustments, and referential reliance on multiple precedents.

Legal Issues Presented

The opinion addresses a procedural and adjudicative determination of entitlement under an insurance-related consumer dispute but does not frame distinct legal issues in the form of numbered questions.

Arguments of the Parties

The opinion contains a record of specific submissions and factual contentions by the parties. The main arguments as recorded in the text are summarized below.

Complainant's Arguments

  • The complainant placed before the forum a chronology and documents relating to an insurance claim, including hospital records and details of payments or claimed amounts (the opinion records figures such as "22,90,000" and references to other sums and payments in the documentation submitted).
  • The complainant relied on medical records and on the claim process conducted in October–November 2017 and subsequent dates, and asserted entitlement to the insurance benefits as set out in the submitted records (the opinion records that the complainant's side produced medical evidence and claim documents for the forum to consider).
  • The complainant sought the forum's intervention to secure payment or relief under the insurance arrangement, as reflected by the complaint record and the documents placed before the forum.

Respondent No.2's (Insurer / Opposing Party) Arguments

  • Respondent No.2 placed before the forum arguments and medical-evidence-based contentions indicating that the insured had diagnoses including Pulmonary Tuberculosis and Diabetes Mellitus; the opinion records that respondent No.2 relied on medical history, prior admissions and investigations when presenting its case.
  • Respondent No.2 maintained that relevant medical examinations, treatment chronology and the nature of ailments (including references to empyema thoracic, pneumothorax and a left upper lobe lobectomy performed on 05.07.2018) were material to the claim and the liability question; the opinion reproduces respondent No.2's factual and medical assertions.
  • Respondent No.2 relied upon expert/forensic evaluations and documentary evidence (dates and hospital records) to support its position about the claim; respondent No.2 also cited earlier judicial decisions in support of its contentions (the opinion records a list of cases relied upon by respondent No.2).

Table of Precedents Cited

Precedent Rule or Principle Cited For Application by the Court
Civil Appeal No. 8245/2015 Sulbha Prakash Motegaonkar and others Vs. Life Insurance Corporation of India on 05.10.2015 (2015 SCC OnLine SC 1880) The opinion records that this case was relied upon by the complainant's side; the specific rule/principle invoked is not detailed in the opinion. The opinion records the citation; no detailed application of the precedent is explained in the text.
Consumer Case No. 88/2011 Pratibha Bevinal Vs. Metfife India Insurance Co. Ltd. on 07.10.2022 (NC) The opinion records that this case was relied on by the complainant's side; the opinion does not state a specific principle attributed to it. The opinion records the citation; no detailed application of that case to the facts is set out in the opinion text.
First Appeal No. 1071/2018 Sucha Singh Vs. Head Branch Office, HDFC Life & Anr. on 21.09.2022 (NC) The opinion records that this case was cited by the complainant's side; the opinion does not specify the particular legal principle cited from it. The opinion records the citation; no further exposition of its application appears in the text.
Appeal (Civil) No. 8701/1997 Ravneet Singh Bagga Vs. KLM Royal Dutch Airlines and Anr. on 02.11.1999 (SC) The opinion records respondent-side reliance on this authority; the specific rule/principle cited is not described in the opinion. The opinion notes the citation; the text does not elaborate how the Court applied it.
Life Insurance Corporation .... Vs. Smt. G.M. Channabasemma on 06.12.1990 (SC) (reported AIR 1991 SC 392 / (1991) 1 SCC 357 and other citations recorded in the opinion) The opinion records reliance on this line of authorities by the respondent; the precise principle cited is not specified in the opinion text. The opinion lists the precedent among those relied upon; the opinion does not provide a detailed point-by-point application in the text.
Mithoolal Nayak Vs. Life Insurance Corporation of India on 15.01.1962 (1962 AIR 814) The opinion records the case as cited by respondent-side submissions; no specific legal principle is quoted in the opinion. The opinion records the citation; no explicit application or discussion is provided in the opinion text.
Satwant Kaur Sandhu Vs. New India Assurance Company Ltd., Civil Appeal No. 2776/2002 (reported on 19.07.2009 (SC) in the opinion) The opinion records that this case was cited by respondent-side submissions; the text does not specify the rule/principle extracted from it. The opinion lists the precedent as relied upon; the opinion text does not show detailed judicial engagement with the precedent.

Court's Reasoning and Analysis

The opinion proceeds by examining the documentary and medical record submitted in the complaint file and the submissions of both parties. The record reproduced in the opinion contains:

  • a chronology of medical events, admissions and interventions (including hospital admissions, surgical intervention with a reference to a left upper lobe lobectomy on 05.07.2018 and subsequent dates of follow-up and investigations);
  • medical diagnoses and expert/forensic observations recorded in the claim file (the opinion expressly refers to diagnoses such as Pulmonary Tuberculosis with Empyema Thoracic, pneumothorax and bronchopleural fistula in the documentary record);
  • the parties' exchange of contentions on non-disclosure, prior treatment history and the admissibility/weight of medical evidence; and
  • citation of earlier judicial authorities by both sides (the opinion lists those authorities and records that the parties relied upon them).

The Court's analytical approach, as recorded, was to review this chronology and the competing factual and expert contentions and then to record its operative directions. The opinion records specific findings about the medical record and the sequence of treatments, notes the submissions of respondent No.2 regarding previous medical history and imaging/tests, and refers to expert/board observations made in the file. The opinion does not set out a long-form doctrinal analysis tying each cited precedent to particular legal propositions in the manner of a law-report judgment; rather, the Court examined the material facts, the parties' submissions and the authorities cited, and then proceeded to make the orders reproduced in the operative part of the opinion.

Holding and Implications

The Court pronounced its order on 05 December 2022 and recorded operative directions in the opinion (the operative paragraphs are reproduced in the source text).

The direct orders recorded in the opinion (as reproduced in the provided text) are given below in verbatim form so as to preserve fidelity to the source. The language below is taken from the operative paragraphs as they appear in the opinion text:

1- fo:} i{kdkj dzekad&2] fo:} i{kdkj dzekad&1 dks e`rd dh leLr cdk;k _.k jkf'k cSad ds laiw.kZ C;kt lfgr vkt fnukad ls 01 ekg ds Hkhrj Hkqxrku djsxkA 2- ;fn e`R;q i'pkr~ ifjokfnuh us dksbZ _.k fd'r dk Hkqxrku fd;k gks rks og okil izkIr djus dh vf/kdkjh gksxh ftldk Hkqxrku fo:} i{kdkj dzekad&2] ifjokfnuh dks djsxkA 3- fo:} i{kdkj dzekad&2 }kjk fo:} i{kdkj dzekad&1 dks laiw.kZ cdk;k _.k jkf'k C;kt lfgr Hkqxrku djus ds i'pkr~ fo:} i{kdkj dzekad&1 ifjokfnuh ds i{k esa uks M~;wt izek.k&i= tkjh djsxkA 4- fo:} i{kdkj dzekad&2] ifjokfnuh dks ekufld larki ds fy, 50]000@&¼ipkl gtkj :i;s½ rFkk okn O;; ds :i esa 10]000@&¼nl gtkj :i;s½ Hkqxrku djsxkA 5- ;fn ikWfylh ds varxZr vU; dksbZ ykHk ifjokfnuh izkIr djus dh vf/kdkjh gksxh rks fo:} i{kdkj dzekad&2] ifjokfnuh dks og Hkh iznku djsxkA

These operative paragraphs are reproduced from the opinion text. They set out the specific directions and contingencies ordered by the forum. The opinion also records that the parties and the forum had before them the medical records, expert observations and citations to precedent that informed the Court's decision to issue these directions.

Implications

The immediate effect of the Court's order is the issuance of the directions reproduced above (dates, payments and procedural contingencies are set out verbatim in the operative paragraphs). The opinion does not state that it is laying down a new legal precedent; rather, it records the adjudicative disposition of the consumer dispute on the facts and the documentary/medical record before it and cites earlier authorities relied upon by the parties. Any broader doctrinal implications are not discussed at length in the opinion text provided.

Pronounced on: 05 December 2022. Source: Consumer Complaint No. CC/2020/13 (document provided).

Show full summary ...

    Smt. Tuleshwari Sahu v. Uco Bank & Anr.

    Consumer Complaint No. CC/2020/13 Smt. Tuleshwari Sahu Vs.

    Uco Bank & Anr. Date of Pronounced on 05 .12.2022 Allowed Page 1 of 7

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    2

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    3

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    4

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    5

    mijksDrkuqlkj dh xbZ lk{; foospuk vkSj nLrkostksa ls ,slk dksbZ Hkh rF; izdV ugha gksrk gS fd fnukad&31-10-2017 ds iwoZ e`rd ;ksxs'k dqekj lkgw us viuk dHkh dksbZ mipkj djk;k gS ;k fdlh fpfdRld us mipkj fd;k gS ;k dksbZ fizfLdzI'ku fy[kk gS vkSj u gh dksbZ dksbZ fpfdRlh; lk{; gS blfy, egRoiw.kZ rF;ksa dks ikWfylh fy;s tkus ds fnu fNik;k x;k Fkk ,slk izekf.kr ugha gksrk gSA 13- fnukad&31-10-2017 dks e`rd ;ksxs'k dqekj lkgw dks ,slk dksbZ Kkr Fkk fd mls Pulmonary Tuberculosis with Empyema Thoracic tSlk fd ,usD'pj&bZ ¼52½ esa mYysf[kr fd;k x;k gS ,oa mipkj ds iwoZ ,usD'pj&bZ ¼43½ esa mYysf[kr OLD PTB WITH EMPYEMA WITH PNEUMOTHORAX WITH BPF S/P LEFT UPPER LOBE LOBECTOMY ON 05.07.2018 gksuk mls Kkr Fkk ,slk Hkh izdV ugha gSA ,slh fLFkfr esa miyC/k laiw.kZ lk{; vkSj nLrkostksa ds ifj'khyu ls ,slk dksbZ Hkh rF; izdV ugha gksrk gS fd e`rd ;ksxs'k dqekj lkgw us ikWfylh fy;s tkus ds iwoZ vius ?kks"k.kk&i= esa egRoiw.kZ rF;ksa dks fNik;k ;k feF;k nqO;Zins'ku fd;k gksA fnukad&31-10-2017 dks chek fd;k x;k Fkk vkSj fnukad&04-08-2018 dks chfer O;fDr ;ksxs'k dqekj lkgw dh e`R;q dkfjr gqbZ gSA ,slh fLFkfr esa bl iwjh vof/k esa e`rd iw.kZr% LoLFk FkkA mldk fnukad&31-10- 2017 ds iwoZ dHkh dksbZ mipkj gqvk gks ,slk dksbZ rF; izekf.kr ugha gSA ,slh fLFkfr esa tks rF; Lo;a e`rd ds Kku esa ugha gS mlds laca/k eas fdlh izdkj dh ?kks"k.kk dh tkos ;k rF;ksa dks O;Dr fd;k tkos] ,slh vis{kk ugha dh tk ldrhA ,slk dksbZ lk{; ugha gS ftlls ;g Li"V gks fd e`rd us lafonk vf/kfu;e] 1872 dh /kkjk&17 ,oa 18 ds rgr diV ;k nqO;Zins'ku fd;k gksA e`rd ;ksxs'k dqekj lkgw us iziksty ,oa fMDysjs'ku QkeZ esa fdlh Hkh egRoiw.kZ rF;ksa dks ugha fNik;k gSA

    6

    14- fo:} i{kdkj dzekad&2 }kjk izLrqr U;k; n`"Vkar bl izdj.k ds rF;ksa ls fHkUu gksus ds dkj.k mudk ykHk mls ugha fn;k tk ldrkA 15- mijksDr laiw.kZ foospuk ds izdk'k esa ge ifjokfnuh dk ifjokn vkaf'kd :i ls Lohdkj djrs gSa ,oa vknsf'kr djrs gSa fd%&

    1- fo:} i{kdkj dzekad&2] fo:} i{kdkj dzekad&1 dks e`rd dh leLr cdk;k _.k jkf'k cSad ds laiw.kZ C;kt lfgr vkt fnukad ls 01 ekg ds Hkhrj Hkqxrku djsxkA

    2- ;fn e`R;q i'pkr~ ifjokfnuh us dksbZ _.k fd'r dk Hkqxrku fd;k gks rks og okil izkIr djus dh vf/kdkjh gksxh ftldk Hkqxrku fo:} i{kdkj dzekad&2] ifjokfnuh dks djsxkA

    3- fo:} i{kdkj dzekad&2 }kjk fo:} i{kdkj dzekad&1 dks laiw.kZ cdk;k _.k jkf'k C;kt lfgr Hkqxrku djus ds i'pkr~ fo:} i{kdkj dzekad&1 ifjokfnuh ds i{k esa uks M~;wt izek.k&i= tkjh djsxkA 4- fo:} i{kdkj dzekad&2] ifjokfnuh dks ekufld larki ds fy, 50]000@&¼ipkl gtkj :i;s½ rFkk okn O;; ds :i esa 10]000@&¼nl gtkj :i;s½ Hkqxrku djsxkA

    5- ;fn ikWfylh ds varxZr vU; dksbZ ykHk ifjokfnuh izkIr djus dh vf/kdkjh gksxh rks fo:} i{kdkj dzekad&2] ifjokfnuh dks og Hkh iznku djsxkA

    ¼ U;k;ewfrZ xkSre pkSjfM+;k ½ ¼ Jherh :fp xks;y ½ ¼ izeksn dqekj oekZ ½ v/;{k lnL; lnL;

    Pronounced on-05 December 2022

    7

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    Smt. Tuleshwari Sahu v. Uco Bank & Anr.
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