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2005 Supreme(Del) 19

High Court Of Delhi
MUKUT LAL DUGGAL - Appellant
Versus
UNITED INDIA INSURANCE CO.LTD - Respondent
W.P.(C.) : 4912 of 2003
Decided On : 01/07/2005

Advocates Appeared:
B.B.SAWHNEY, B.K.SUD, S.C.DHANDA

Headnote:Insurance - Renewal of Mediclaim Policy — Refusal of Insurance Company to renew the Mediclaim on the ground that claim ratio of the insured was high — Improvement of public health is a duty of State — Case fully covered by the decision of Division Bench — Held that renewal of policy cannot be refused even if insurance covered becomes more onerous or burdensome — Direction given to the Insurer to renew the policy with further direction to pay interest on delay in making payment of the claim made by the insured.

Sanjay Kishan Kaul, J.

( 1 ) THE necessity of prompt medical attention in case of emergency cannot but be emphasised. In the absence of any social security systems in this behalf, the insurance companies had come up with the mediclaim policies to cater to such medical emergencies. The cost of medical treatment has increased manifold over a period of time and thus appropriate medical treatment can be out of the reach of citizens unless the citizens are covered by such medi-claim policy.

( 2 ) THE petitioners are husband and wife and got themselves insured under the Mediclaim Insurance Scheme of the respondent insurance company in 1995-96. Petitioner No. 1 in July, 1998 suffered coronary disease and was admitted in the Escorts Heart Institute and Research Centre where he underwent angioplasty. The claim made for medical treatment was paid by the respondent. In April 2000 petitioner No. 2 also got herself insured and a single policy was issued. In January 2001, petitioner No. 1 was once again admitted to the Escorts heart and Research Centre and was again advised to get Angioplasty done which was undertaken in June 2001. These amounts were reimbursed in august 2001 by the respondent.

( 3 ) IN May 2002, petitioner No. 1 was hospitalised in Holy Family Hospital for a minor operation and the medical expenses claimed were again reimbursed. Petitioner No. 1 was again required to be hospitalised on 4. 12. 2002 on account of uneasiness and chest pain and had to undergo by-pass surgery. The petitioner was discharged after the by-pass surgery and the bill raised by the hospital for Rs. 2,20,292/- was settled by petitioner No. 1 by arranging funds from various sources. The petitioner submitted the claim on 6. 1. 2003. The payment was, however, not made. During this period of time no occasion ever arose for petitioner No. 2 to claim any medical reimbursement.

( 4 ) SINCE insurance policy has been extended till the midnight of 5. 4. 2003, petitioner No. 1 approached the respondent on 3. 4. 2003 for renewal of the policy for himself and his wife and submitted the cheque for the premium for renewal of the policy for the year 2003-2004. This cheque was refused by the respondent and the reason for the same is stated to be the advise of the divisional Manager of the respondent company that because of the high claim ratio, the respondent was unable to renew the policy.

( 5 ) THE petitioner issued a legal notice dated 5. 5. 2003 seeking renewal of the policy and once again enclosed the cheque for the premium. The petitioner received a response from the respondent dated 19. 5. 2003 stating that due to the high claim ratio respondent was not in a position to renew the policy and the cheque sent along with notice was returned. Interestingly there was silence on the part of the respondent insofar as the coverage for petitioner No. 2 was concerned since undisputedly there was no claim made by petitioner No. 2. Respondent remitted the cheque for Rs. 8673/- to petitioner No. 1 in June 2003 towards the claim lodged in June 2002.

( 6 ) THE petitioner finally filed the present writ petition seeking quashing of the letter dated 19. 5. 2003 and seeking directions against the respondent to renew the policy. The petitioner further claimed relief of reimbursement of the amount of medical expenses admittedly covered by the policy which had been withheld by the respondent. Lastly the petitioner has prayed for exemplary cost for mental torture, harassment and agony by denying the rights of the petitioners.

( 7 ) THE defence put up by the respondent is that the transaction in question is a contract between the parties and despite the respondent being a Government undertaking, the reliefs claimed for in the petition cannot be granted in exercise of jurisdiction of Article 226 of the Constitution of India. It has been stated that the respondent cannot be compelled to enter into a contract of insurance. The reason for the rejection of the renewal has been justified on t





























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