Page 41 - Suri’s - NCDRC ON LIFE INSURANCE 2017 V1.3

Suri’s - NCDRC ON LIFE INSURANCE 2017 41

fraud committed by the insured in any manner.
10. Further, it has been stated that the insured had taken treatment in Ghaziabad
impersonating himself as Ravindra Singh and enjoyed the benefits under the Central
Government Health Scheme (CGHS) in the name of Ravindra Singh. The informa-
tion obtained under the Right to Information Act reveals that Ravindra Singh 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 Brijendra
Singh, who had taken the treatment or it was Ravindra Singh. It is, therefore, neces-
sary 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 recorded above that
the order of the State Commission has not taken into account the crucial issue in-
volved 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.
11. Both these first appeals are disposed of with the directions that the matter
shall be re-heard and decided by the State Commission, after affording an opportunity
to both the parties to lead further evidence, if any in their favour. The parties have
been directed to appear before the State Commission for further proceedings on
15.12.2017. There shall be no order as to costs.

......................
DR. B.C. GUPTA
PRESIDING MEMBER
......................
DR. S.M. KANTIKAR
MEMBER

INDEX