NCDRC

NCDRC

RP/144/2009

VIMAL SARDANA - Complainant(s)

Versus

THE ORIENTAL INSURANCE CO. LTD. - Opp.Party(s)

MR. RAJESH RAINA

13 Apr 2010

ORDER


NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSIONNEW DELHIREVISION PETITION NO. 144 OF 2009
(Against the Order dated 25/09/2008 in Appeal No. 1122/2004 of the State Commission Uttar Pradesh)
1. VIMAL SARDANAW/o Sh. M.L. Sardana, R/o H. No.767, Sector-19,NoidaUTTAR PRADESH ...........Petitioner(s)
Versus
1. THE ORIENTAL INSURANCE CO. LTD. Through its Regional Manager, Regional Office at Jeevan Bhawan, Hazrat Ganj,LucknowUTTAR PRADESH ...........Respondent(s)

BEFORE:
HON'BLE MR. JUSTICE B.N.P. SINGH ,PRESIDING MEMBERHON'BLE MR. S.K. NAIK ,MEMBER
For the Petitioner :NEMO
For the Respondent :NEMO

Dated : 13 Apr 2010
ORDER

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Though Registry has reported delay of 12 days in preferring revision petition beyond prescribed period of limitation for which an application for condonation of delay has been filed by petitioner stating that there has been delay of only 8 days. However, having gone through the reasonings assigned therein, we hereby condone the delay. Petitioner – claimant is against order of reversal of District Forum by State Commission. Factual matrix are that petitioner along-with her husband in their joint names had taken a Medi-claim insurance policy of Rs. 1,00,000/- each in her name and also her husband in the year 1994-95 which was renewable every year. Last policy that is material for consideration bears No. 200/508 and this was effective for the period from 28.11.2001 to 27.11.2002. While policy was in vogue and it was to terminate on 27.11.2002, petitioner moved respondent – Corporation sending a cheque for Rs. 3,691/- on 21.11.2002 for renewal of policy. However, move made by petitioner did not find favour with Insurance Corporation which declined renewal of policy on 26.11.2002 holding “bad claim experience”. Even though petitioner twice moved Insurance Corporation with presentation of cheque for renewal of policy, that too did not yield desired result. It seems that during December, 2002, both husband and wife having suffered ailment were hospitalized in Cumballa Hill Hospital & Heart Institute, Mumbai for treatment and after getting discharge from hospital, moved Insurance Corporation for reimbursement of medical expenses of Rs. 1,23,953/- incurred over treatment. Since claim was not settled by insurance company, a consumer complaint was filed with District Forum. We are told that Insurance Corporation had declined renewal of insurance policy also holding that renewal of policy was sought only to cover medical expenses over their treatment which they were likely to incur during their hospitalization in December, 2002. District Forum, however, having negatived objections raised by respondent Corporation, accepting complaint, directed Insurance Corporation to pay compensation of Rs. 50,000/- (Rs. 25,000/- each). There was also default clause for payment of interest in case award was not honoured within time specified. Both Insurance Corporation and also claimant filed individual appeals before State Commission. While Insurance Corporation challenged propriety of finding of District Forum about recording deficiency in service on part of Insurance Corporation, Claimant had challenged finding of District Forum for having not accepted claim for reimbursement of medical expenses incurred over their treatment. State Commission in its conclusive finding, while accepting appeal of Insurance Corporation, dismissed appeal of claimant. It is how that claimant is in revision. Though insurance policy is subject to renewal, yet it is dependent on mutual consent of parties and, also that insurance policy does not confer legal right on insured for its automatic renewal, the courts are required to strike a balance as to whether insurance company were well within their right to decline renewal of insurance policy with reasonableness and transparency. This needs no repetition that right to cancel policy or refusal to renew policy must be confined to exclusionary clauses contained in policy. That apart, this legal proposition too, cannot be disputed that there can be cancellation of policy on grounds of mis-representation, fraud and non-disclosure of material facts. Rightly, none of these grounds which can be taken as exception either for cancellation of policy or renewal thereof, are with case of petitioner – claimant, though we are told that renewal of policy was declined by insurance Corporation apprehending submission of claim for reimbursement of medical expenses, when couple were likely to be hospitalized in Cumballa Hill Hospital & Heart Institute, Mumbai, sometimes in December, 2002. As was observed by Hon’ble Apex court in the matter of Biman Krishna Bose Vs. United India Insurance Co. Ltd. & Anr. – III (2001) CPJ 10 (SC) that since insurance companies have trappings of ‘State’ under Article 12 of the Constitution of India, they are expected to act fairly and reasonably in their action while dealing with customers. Even in an area of contractual relations, the ‘State’ and its ‘instrumentalities’ are enjoined with the obligation to act with fairness and in doing so, can take into consideration only the relevant materials. They must not take any irrelevant and extraneous consideration while arriving to a decision. That apart, arbitrariness should not appear in their actions or decisions. Aforesaid ratio of decision was further reiterated by Hon’ble Apex court in the matter of United India Insurance Co. Ltd. Vs. Manubhai Dharmasinhbhai Gajera & Ors. – II (2008) CPJ 43 (SC) that though insured was not entitled to automatic renewal but is entitled to be treated fairly. Least said is better about grounds on which renewal of policy sought by petitioner was declined by respondent company, as expression is too vague and obscure. It does not import true meaning which respondent intended to convey to insured. Even no backgrounds for ‘bad claim experience’ were highlighted in rejection letter. Since lack of reasonableness and transparency is writ large on face of refusal of renewal of policy, State Commission was evidently in error in unsuiting petitioner and accepting appeal of insurance company. Since medi-claim policy taken by petitioner in the year 1994-95 was being renewed by respondent Corporation till 27.11.2002 from time to time and there was no evidence about laxity on part of petitioners about payment of premium beyond due time, we accordingly set aside order of State Commission and hold that petitioners were very much eligible for renewal of medi-claim policy which was in joint names of the couple. Policy in question must be construed to have been renewed after it expired on 27.11.2002. All consequential benefits from renewal of policy from aforesaid date must flow to petitioners. However, so far as reimbursement of medical expenses incurred over treatment is concerned, we direct that it shall be considered by respondent Corporation in the light of observations made hereinabove and it is expected that respondent Corporation will settle the matter, within a period of four months from the date of this order. Revision petition accordingly, succeeds but with no order as to cost.



......................JB.N.P. SINGHPRESIDING MEMBER
......................S.K. NAIKMEMBER