MR. JUSTICE V.K.JAIN, PRESIDING MEMBER (ORAL) The complainant/petitioner obtained an insurance policy namely ‘Individual Nagrik Suraksha Policy’ from the respondent for the period from 29.08.2008 to 28.08.2009. In terms of the aforesaid policy, out of the insured amount of Rs.1,00,000/-, Rs.80,000/- were payable in case of personal accident and Rs.20,000/- were payable for undergoing treatment in a case of accidental injury. On expiry of the said policy, a new policy for the period from 29.08.2009 to 28.08.2010 was issued but the said policy was different from the previous policy and was known as ‘Individual Accident Insurance Policy’. Under the new policy, a sum of Rs.50,000/- was payable in the event of death of the insured and 25% of the sum insured was payable for the treatment in case of an accidental injury. 2. The petitioner/complainant having met with an accident on 05.07.2010, he was admitted in a hospital and had to incur expenditure of Rs.44,399/-. However, his claim was sanctioned only to the extent of Rs.9,642/- in terms of the policy which had been issued for the period from 29.08.2009 to 28.08.2010. Being aggrieved, he approached the concerned District Forum by way of a Consumer Complaint. 3. The complaint was resisted by the insurer primarily on the ground that the change in the policy had happened on the request of the complainant and if he had an objection to the new policy, he could have got the same cancelled during the lookout period. It was also pointed out by the insurer that in the previous policy taken by the complainant, there was no provision for re-imbursement of expenditure incurred on treatment without admission in a hospital whereas under the second policy, such benefit was available to the insured. During the pendency of the complaint, the insurance agent Mr. Pramod Pajiyar was impleaded as a party to the consumer complaint, on the request of the complainant. He filed his reply supporting the stand taken by the insurer and stated that the change in the policy had happened on the request of the complainant. 4. The District Forum having dismissed the complaint, the petitioner/complainant approached the concerned State Commission by way of an appeal. The said appeal also having been dismissed, he is before this Commission by way of this revision petition. 5. The only question involved in this petition is as to whether the change in the policy for the period from 29.08.2009 to 28.08.2010 had happened with or without the consent of the complainant. It is true that no written request or proposal form for the change of the policy was produced by the insurer before the District Forum. However, the agent, who was impleaded as a party to the complaint on the request of the complainant himself, clearly stated that the change in the policy had happened on the request of the complainant. I see no reason to disbelieve the statement made by the insurance agent through whom the policy had been taken. This is more so when he was impleaded as party to the consumer complaint, on the request of the complainant himself. 6. The second policy, as noted earlier, started with effect from 29.08.2009. The petitioner/complainant got injured on 05.07.2010, which was more than ten months after the second policy had started. If the second policy was not acceptable to him, or it was issued without his request, he ought to have protested and returned the policy, during the lookout period, claiming that the change in the policy was not acceptable to him. That admittedly, was not done. In fact, no such communication was sent by the complainant to the insurer even after the lookout period had expired. Therefore, the obvious inference is that the change in the policy had happened with the consent of the complainant. The view taken by the fora below therefore, does not call for any interference by this Commission in exercise of its revisional jurisdiction. The revision petition, being devoid of any merits, is hereby dismissed. Fee of the Amicus Curiae be paid as per rules. |
