JUSTICE V.K. JAIN (ORAL) This revision petition is directed against the order of the State Commission dated 14.1.2015 whereby the appeal filed by the petitioner against the order of the District Forum dated 1.9.2014 was dismissed on merits. Late Shri Bhag Ram, father of the complainant obtained an insurance policy from the respondent on 27.9.2010. He having died on 1.8.2012, a claim in terms of the policy was lodged by the complainant with the respondent. The claim, however, was repudiated vide letter dated 16.2.2013 which to the extent it is relevant reads as under:- “This is with reference to the death claim received under the above-mentioned policy, we regret to inform you that we have decided to repudiate the claim on the grounds of suppression of material information. In this connection, we have noted that in the proposal for insurance received by us on September 29, 2010 (copy of the proposal from enclosed), relevant questions were answered as follows:- Q. No. | Question | Answer | 22(a) | Are you presently in good health? Please submit Previous Medical Reports (if any) as receipt of these reports helps us in faster assessment of the health of the life to be assured. | Yes | 23(c) | Have you ever consulted any doctor or are you currently undergoing/have undergone any tests, investigations, awaiting results of any tests or investigations or have you ever been advised to undergo any tests, investigations or surgery or been hospitalized for general check up, observation treatment or surgery? | No | 23(d) | Are you aware of or have you ever been treated or hospitalized for cancer, tumor, cysts or any other growths? | No | 23(e) | Have you ever been referred to an oncologist or cancer hospital for any investigation or treatment? | No | 23(f) | Did you have any ailment/injury requiring treatment/medication for more than a week? | No |
Relying on the replied/declarations provided in the proposal for insurance, the above policy was issued on November 10, 2010. The Life Assured expired on August 01, 2012 due to “Adenomorphic Carcinoma Floor of Mouth” being the primary cause and “Metastatis” being the secondary cause of death. After careful evaluation of the records obtained by us, during the claim processing, it is noted that the Life Assured was hospitalized on August 18, 2010 and was diagnosed of “Carcinoma Floor of Mouth” and received chemotherapy treatment for the same.” 2. Since the claim was not paid, the complainant approached the concerned District Forum by way of a consumer complaint. 3. The complaint was resisted by the respondent primarily on the ground that the deceased insured was suffering from Carcinoma Floor of Mouth, but the aforesaid ailment was concealed by him while submitting the proposal for grant of the insurance policy. 4. It is an admitted position that no doctor from Jindal Hospital where the deceased insured was allegedly admitted and treated before taking the policy was examined. No record clerk from the aforesaid hospital was summoned in order to prove the record relied upon by the respondent to prove the aforesaid ailment. The repudiation letter does not find any reference in the consumer complaint, the simple stand taken in the complaint being that the claim had not been paid. Though the plea of the alleged sickness of the insured was taken in the reply filed before the District Forum, no rejoinder was directed to be filed. It is also the contention of the learned counsel for the parties that they were not called upon to lead evidence. As a result, the complainant could not file the evidence to prove that the deceased was not admitted in Jindal Hospital and was not suffering from the ailment attributed in the repudiation letter. In these circumstances, it becomes necessary to remit the matter back to the District Forum to decide the complaint afresh after giving an opportunity to the parties to lead evidence on the question as to whether the deceased was admitted in the O.P. Jindal Institute of Cancer & Research on 18.8.2010 and where he was suffering from Squamous Cell Carcinoma with mild to moderate nuclear pleomorphism and hyperchromasia. 5. The impugned orders are, therefore, set aside. The parties are directed to appear before the concerned District Forum on 6.4.2017. The District Forum shall decide the complaint afresh in terms of this order, within three months of the parties appearing before it. | 
