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Suri’s - NCDRC ON LIFE INSURANCE 2017 37

(i) IRDA (Policy Holders Interests) Regulations, 2002, Regulation 8(3) – In-
surance company should have been decided by the opposite party Nos. 1 and 2
within a period of 30 days and not more than 6 months i.e. latest by March, 2012 -
Thus, it was an utter disregard of the statutory provisions; the opposite party
nos. 1 and 2 repudiated the claim on 19.3.2013, which took 2 years and three
months to take decision in this matter - The basic issue involved in the present
matter is whether the insured, suffered from any kidney disease etc. prior to sub-
mitting the proposal form for obtaining the policy and whether there has been any
concealment of any material fact on his part - A perusal of the impugned order
reveals that although the State Commission identified the crucial issue as stated
above but they have not given any finding on the same, rather the State Commis-
sion passed their judgment based on the IRDA Regulations 2002 only, saying that
the insurance company had indulged in deficiency in service in not deciding the
claim within the time laid down in the Regulations - It was the duty of the State
Commission to have examined the entire evidence on record and then give a clear-
cut finding on the question, whether there was any impersonation or fraud com-
mitted by the insured in any manner. [Para 9]

(ii) Fraud – Duty of state commission - Insured B - It has been stated that the
insured had taken treatment in Ghaziabad impersonating himself as R and en-
joyed the benefits under the Central Government Health Scheme (CGHS) in the
name of R - The information obtained under the Right to Information Act re-
veals that R was a constable in Delhi Police and was suffering from neck problem
only - The State Commission should have examined the relevant medical record
available at the places, where the treatment was taken in order to find out
whether it was B, who had taken the treatment or it was R - It is, therefore, nec-
essary that the matter be thrashed out in detail to bring out, whether there has
been an act of fraud on the part of the insured. It is evident from the facts re-
corded above that the order of the State Commission has not taken into account
the crucial issue involved in the matter and decided the case, based on technical
aspects only. The order passed by the State Commission is, therefore, perverse in
the eyes of law and the same is hereby set aside. [Para 10]

NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION
NEW DELHI

FIRST APPEAL NO. 1432 OF 2014

(Against the Order dated 30/09/2014 in Complaint No. 64/2013 of the State Com-
mission Uttar Pradesh)
1. TATA AIA LIFE INSURANCE COMPANY
LIMITED & ANR
(FORMERLY KNOWN AS TATA AIG LIFE
INSURANCE OMPANY LIMITED) 5TH AND ...........Appellant(s)

INDEX