ORDER

AVM J. Rajendra, AVSM, VSM (Retd.), Member—The present First Appeal has been filed under Section 19 of the Consumer Protection Act, 1986 (hereinafter referred to as “the Act”) against the Order dated 08.10.2018 passed by the State Consumer Disputes Redressal Commission, Bihar (hereinafter referred as “the State Commission”), in Consumer Complaint No.21 of 2017, wherein the Complaint filed by the Complainant (Appellant herein) was dismissed.

2. For the sake of Convenience, the parties in the present matter being referred to as mentioned in the Complaint before the State Commission. “Mrs. Sushila Singh” is identified as the Complainant who is wife and nominee of the insured policy holder Late Shri Sanjay Kumar (Since deceased). “The Birla Sun Life Insurance Co. Ltd. & Others” are referred to as the Opposite Parties or Insurer in this matter.

3. There was 26 days delay in filing the present Appeal. For the reasons stated in IA/23780/2018, vide Order dated 26.09.2022, the delay was condoned.

4. Brief relevant facts of the case as per the Complainant are that the Husband of the Appellant/Complainant (‘Insured’ for short) obtained a Life Insurance Policy (Dream Endowment Plan), vide policy No. 004334095 with annual premium of Rs.25,524. It covered the insured for Death benefit of Rs.50,00,000/- (Sum Assured for Rs.3,00,000/- and Enhanced Sum Assured for Rs.47,00,000/-). This policy was proposed on 16.08.2010 and was issued on 31.08.2010 for a term of 30 years. Payments for two years was effected and, however, during the year 2012-2013 the policy lapsed on account of non-payment of the third premium installment, due to the alleged insurance advisor’s negligence. Thereafter, it was reinstated on 11.03.2013 and the premium instalment due was paid. Notably, during the reinstatement, the Insured was diagnosed with a kidney ailment. This was disclosed to the insurance advisor, who failed to record this crucial health information in the revival form. The Insured passed away on 20.12.2013 while undergoing treatment at Medanta Hospital. Thereafter, as the designated nominee in the policy, his wife claimed the insured amount. The claim was, however, repudiated.

5. Being aggrieved, the Complainant filed consumer complaint No. 21 of 2017 before the State Commission, sought insured amount of Rs.50/- Lacs with interest @16% p.a. from the date of submission of the claim till actual payment and compensation on account of mental agony.

6. The OPs/Insurer, in their written version, denied her claim stating that the complaint lacks merit. The policy in question was initially issued to Shri Sanjay Kumar under policy No. 004334095 on 31.08.2010. But, it lapsed on 30.09.2012 due to non-payment of the premium amount. The policy was reinstated on 11.03.2013 based on a Certificate of Insurability (COI) dated 07.03.2013 signed and submitted by late Shri Sanjay Kumar. This certificate indicated that the life assured was not afflicted by any illness, disease, or injury before the policy’s reinstatement.

7. The investigation by the OPs/Insurer revealed that the policyholder was suffering from kidney related problems and was undergoing dialysis before the policy was reinstated by the OPs. It was further stated that when a policy lapses and is subsequently reinstated, it is treated as a fresh insurance contract. Therefore, the life assured was obligated to provide accurate and complete information about their health.

8. The OPs emphasized that agents act as representatives of the insured and, however, they cannot promise anything beyond the terms and conditions set by the insurer. The life assured, possessing insurable interest, should not have blindly relied on a third party and signed the documents, without understanding its contents. Hence, the OPs/insurer repudiated the claim on 18.11.2014 and refunded the premium amount of Rs.22,109 to the Complainant by NEFT transfer. Thereafter, she approached the insurance company for reconsideration of the claim. T