This revision is directed u/s 17(i) (b) of CP Act, 1986 against the ex parte/final order passed by Ld. D.C.D.R.F, Cooch Behar in CC No. 34 of 2018 dated 28/11/2018. The revisionist case in nutshell is that his wife A. Pal, since deceased during her life time purchase of two life insurance policies viz. RLIC Guarantee money bank policy bearing no. 51203907 and 51203687. And in that policies the revisionist S. Pal was appointed nominee, being the husband of the since deceased A. Pal. The policy holder used to pay the premiums in due times through agents and the insurance company issued the premium receipt time to time. Thereafter the agent of the life insurance company has failed to deposit the annual premium in due time and for that reason, the policy become lapsed. Thereafter, the said lapsed policy was revalidated after making subsequent premiums as arranged by the insurance company. In this way the policies were revised in force. Thereafter in the month off April, 2015 the policy holder A. Pal failed ill and she was detected with Adenocarcinoma on her lung and she was treated at Rajiv Gandhi Cancer Institute and Research Centre, New Delhi as indoor patient from 16/04/2015 to 20/04/2015 for Chemotherapy and she was advised to revisit on 24/04/2015 the treatment of A. Pal was continued till the death of her took place on 30/09/2017 due to Cardio respiratory failure. After the demise of policy holder as nominee, the revisionist S. Pal submitted his prayer for settlement of the benefit assured in the insurance policy. The insurance company as wrongly repudiated the claim and deprived the revisionist as nominee to get the benefits assured in the policy. So, he registered a consumer complaint for deficiency of service on the part of the insurance company before the Ld. Forum, Cooch Behar. Ld. Forum, Cooch Behar admitted the case on merit and issued notice to the insurance company but the insurance company that is the opposite party of that case did not contest the case by submitting any written version and for that reason the case was heard ex parte. Ld. Forum had decided the consumer complaint on hearing only the complainant/revisionist and found no merit of the case of the complainant and ultimately it was dismissed.

            Being aggrieved with this order this revision follows on the ground that the order passed by the Ld. D.C.D.R.F, was bad in law and not proper, mis appreciation of evidence and mis application of provisions of law. The insurance company after receiving the notice of the revision has secured the company’s appearance before this Commission through Ld. Advocate and has contested the revisional application. The revisional application was heard in presence of both sides through the legal representatives.

Decisions With Reasons.

It is established in this case that after paying some annual premiums the policies become lapsed and further it was revalidated after accepting fresh premium from the person whose life was assured by these policies. Ld. D.C.D.R.F, Cooch Behar at the time of adjudication found that the deceased A. Pal was suffering in Adenocarcinoma in the month of April, 2015 and she was admitted at Cancer Hospital, New Delhi from 16/04/2015 to 20/04/2015 where chemotherapy was applied to the affected portion of the body of the deceased A. Pal from 16/04/2015 to 20/04/2015. The policy holder has expired on 30/09/2017. The claim of the nominee of the deceased was repudiated by the insurance company on30/11/2017 on the ground that A. Pal has submitted a false statement in the declaration of state of health on 22/04/2015. Ld. Forum has dismissed the complaint on the ground that while the policy holder or her men came to know that the days of the policy holder was numbering, then, they revalidated the policy by submitting a false statement in respect of state of health of the policy holder. At the time of hearing the appeal, it is mentioned on the part of the complainant/revisionist that the insurance company has manufactured the documents that is the statement of the policy holder regarding her state of health which actually did not furnish by the policy holder and the signature of the policy holder in the said documents is manufactured one. It is contended on the part of the revisionist that after chemotherapy the condition of the policy holder improved and she was free from any decease of Adenocarcinoma and revalidated the policy while she was quite well in health and free from any disorder or deformities of her body. Ld. Advocate further submits that the said policies not only cover the death benefits but some auxiliary benefits were there that is Guarantee Maturity addition and Guarantee Loyalty addition which was stipulated in the terms and conditions of the said two policies. So, flat repudiation without entertaining any other relieves on the part of the insurance company is totally unauthorized in the insurance rules. And Ld. Forum has failed to assert the exact provision of law and the Ld. Forum had the opportunity to provide some sort of relieves to the unfortunate claimants who has not only lost his life but also all the benefits which he accrued from the terms and conditions of the said two policies. Ld. Advocate of the respondent that is insurance company at the time of his turn placed all his annexure documents that is the treatment, sheets, discharge summary of the policy holder including the declaration of the policy holder regarding her state of health etc. and mentioned that the respondent company neither denied the claim of the revisionist arbitrarily nor performed any unfair trade practice. It was the deceased who has voluntarily signed the good health declaration forms at the time of reinstatement of such insurance policy without even disclosing the material fact of her fatal illness. Therefore, he submits that Ld. Forum has rightly decided the disputes on his own merit and adjudicated not in favour of the revisionist and this appeal should be dismissed for devoiding of any merit. After hearing the valuable arguments of the both sides and after going through all the reliable documents furnished by both parties of this case and after going through the terms and conditions of the insurance policies, the Commission finds that the Ld. Forum has rightly opined that by suppressing material fact before the insurance company the two lapsed policies were revalidated and for that reason, the insurance company has rightly repudiated the claim of the complainant. This portion of adjudication is found partly correct as because the two lapsed insurance policies which were revalidated during lifetime of the policy holder have some other benefits besides the death claim and such benefits should not be curtailed on the ground of concealment of the fatal disease on the part of the policy holder. It is also fact that if we believe that the annexure (g) that is the self-declaration of state of health of the policy holder is manufactured one then also it is clearly established that the said two lapsed policies were reinstated when the desease cancer was detected and it was concealed before the insurance company at the time of revalidation of the policies. So, the Ld. Forum has the option to determine beside the death claim whether there was other relieves to be provided to the nominee of the said policies which were stipulated in the policies itself and which were accepted on the part of the insurance company at the time of accepting the premiums at the time of revalidation of the said two policies. So, Ld. Forum shall adjudicate the dispute again and to determine whether the complainant/revisionist is entitled to get any other relieves consequentially arises to the said two policies barring the sum assured on account of death of the policy holder, thus the revision succeeds.

Hence it is ordered: -

That the revision application u/s 17(i) (b) of CP Act is allowed on contest without cost. The order of Ld. D.C.D.R.F, Cooch Behar dated 28/11/2018 in reference to CC no. 34 of 2018 is hereby set aside. Ld. Forum is asked to look into the matter again after giving the opportunity to the OP to file W.V and to decide the matter on the basis of evidence and documents whether the complainant has got any other consequential relieves arises out of the revalidated insurance policies barring the sum assured for death of policy holder. The OP shall file the W.V, if wishes within 15 days from the date of receiving the free certified copy of the order to be supplied by this Commission. Let a free certified copy of this order be supplied to the parties of this case free of cost and let a copy of this order be communicated to the Ld. D.C.D.R.F, Cooch Behar.