Page 40 - Suri’s - NCDRC ON LIFE INSURANCE 2017 V1.3

Suri’s - NCDRC ON LIFE INSURANCE 2017 40

health condition at the time of inception of the policy. Therefore, on the basis of in-
vestigation report, the claim was repudiated. The OP also sought information through
RTI application from CGHS office as well as Delhi Police. As per RTI information
from the Deputy Commissioner‘s office, Delhi, it was stated that Shri Ravindra Singh
was a constable in Delhi Police and he was suffering from neck problem. Similarly,
RTI information from Chief Medical Officer, Ghaziabad Wellness Centre revealed
that Shri. Ravindra Singh took treatment from Nephrologist, Cardiologist and Gastro-
enterologist. Thus, it proves that the deceased was residing with his real brother,
Ravindra Singh in the same house. The complainant in connivance with Shri Ravin-
dra Singh and deceased has tried to conceal the material fact of the previous illness
and also misrepresented about the treatment taken in the name of Shri Ravindra Singh
under CGHS. The counsel further submitted that the OPs have also lodged the crimi-
nal complaint against the complainant and other persons involved, for the alleged
fraud.
6. Learned counsel for the complainant submitted that claim was lodged with
the financer/bank as well as with the insurance company by means of two separate
letters dated 3.9.2011 and 2.1.2012. The claim in view of the Regulation 8(3) of the
IRDA (Policy Holders Interests) Regulations, 2002, 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. Learned counsel further submitted
that since the loan was secured by OP 3/Financier under the policy taken from OPs 1
and 2. There was no cooperation from the bank as a financier but it threatened the
complainant by a letter in June, 2013 to clear the outstanding dues, otherwise, the
recovery proceedings would be initiated.
7. We have given our thoughtful consideration to the arguments advanced be-
fore us by the learned counsel for both the parties and also carefully examined the
material placed on record, including the orders passed by the State Commission. The
basic issue involved in the present matter is whether the insured, Brijendra Singh suf-
fered from any kidney disease etc. prior to submitting the proposal form for obtaining
the policy and whether there has been any concealment of any material fact on his
part.
8. While passing the impugned order, the State Commission identified the is-
sue correctly and stated as follows:
―A crucial question for determination is that whether in the instant case there
was impersonation or fraud committed by the insured and whether any material
fact regarding the treatment of kidney disease prior to the proposal of policy have
been concealed by the insured.‖
9. 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 Commission passed their judgment based on the IRDA Regula-
tions 2002 only, saying that the insurance company had indulged in deficiency in ser-
vice 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

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