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2009(2) CPR 228 (NC)
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION,
NEW DELHI
Ashok Bhan, President and B.K. Taimni, Member
Life Insurance Corporation of
India —Petitioner
versus
Batthini Rama Rao —Respondent
Revision Petition No. 3254 of 2004
Decided on 24.4.2009
Counsel for the Parties:
For the Petitioner:Mr. Ajay Goswami, Advocate.
For the Respondent: Mr. Nemo.
IMPORTANT POINT
Risk under the policy would be covered from the date on which the policy is issued and not from the date which is mentioned in the policy.
Headnote:Consumer Protection Act, 1986—Sections 12 and 17—Insurance Policy Claim—Complainant took “Asha Deep Policy” on 29.10.1993 and requested to date back policy from 28.9.1993—Policy was issued on 30.11.1993 and date of maturity was 28.9.2018 taking policy to have commenced from 29.9.1993—Complainant underwent heart operation on 10.10.1994—His claim for reimbursement of amount was repudiated on ground of terms of policy that insured was operated within one year of date of issuance of policy—District Forum allowed complaint and State Commission upheld the order holding that policy came into effect on 28.9.1993 and complainant under went heart surgery on 10.10.1994 which was beyond one year—Revision—Risk under the Policy would be covered from the date on which policy was issued and not from the date which was mentioned in policy—Impugned order was liable to be set aside. (Paras 5 & 6)
Result: Revision allowed.
Ashok Bhan, President—Petitioner herein who was the Opposite Party before the District Consumer Disputes Redressal Forum, Nalgonda (hereinafter referred to as ‘the District Forum’ for short), has filed the present Revision Petition.
2. Shortly stated, the facts of the case are:
Complainant-respondent herein had taken a policy called “Asha Deep Policy” in the sum of Rs. 1,00,000/- on a yearly premium of Rs .4,939/-. Respondent submitted a proposal on 29.10.1993. While submitting the proposal, respondent made a request to date back the policy and indicated himself that the policy be back dated from 28.09.1993. The proposal was submitted on 29.10.1993. An amount of Rs. 4,940/- was paid on 19.11.1993 towards the first premium. Accordingly, policy no.643340247 for a sum of Rs.1,00,000/- on yearly premium of Rs. 4, 939/- was issued on 30.11.1993. The date of the maturity is 28.09.2018. Respondent underwent a heart operation of ‘Aortic Valve’ replacement with 23 inches size on 10.10.1994 at Medwin Hospital, Hyderabad. Respondent applied for reimbursement of the amount incurred for the said operation. The claim was repudiated on the ground that in terms of the policy, no reimbursement could be given as the respondent had undergone the operation within one year of the date of the issuance of the policy.
3. Being aggrieved, respondent filed the complaint before the District Forum claiming benefit under (A) and (B) as per terms and conditions of the policy along with interest @ 24% per annum from the date of operation with costs. A sum of Rs. 1,00,000/- was claimed towards the harassment and mental agony. District Forum allowed the complaint aggrieved against which the respondent had filed an Appeal before the Andhra Pradesh State Consumer Disputes Redressal Commission, Andhra Pradesh (hereinafter referred to as ‘the State Commission’ for short) .The State Commission dismissed the Appeal by the impugned Order holding that the policy had come into effect from 28.09.1993 and the respondent underwent the heart surgery on 10.10.1994 which was clearly beyond the period of one year. It was observed as under:
“The complainant has obtained Ashadeep Policy marked as Ex. A-1. Admittedly the assured underwent open Heart By-pass surgery. Hence it is to be held that the policyholder has underwent the operation within the period of insurance and is entitled for reimbursement. The policy was accepted on 28.09.1993 as per Ex.A-1 and he underwent an open heart surgery on 10.10.1994. Hence it is obvious that the assured has not underwent the operation within one year from the commencement of policy. Section 64 VB of the Insurance Act, 1939 has no application. Taking into consideration Exs. A-1 and A-13 the District Forum came to the conclusion that there is deficiency of service on the part of the opposite parties. We do not see any reason to interfere with the well considered order passed by the District Forum.”
4. In spite of Notice, the respondent did not appear and he was ordered to be proceeded ex-parte on 04.03.2009. The case was adjourned for today and the Office was directed to send a copy of the Order dated 04.03.2009 to the respondent. Respondent is not present today as well in spite of Notice.
5. Counsel for the petitioner, relying upon the Judgment of Supreme Court of India in Life Insurance Corporation of v. Dharam Vir Anand1 contends that the risk under the policy would be covered from the date on which the policy is issued and not from the date which is mentioned in the policy. In the present case, the date of issuance of the policy was 30. 11. 1993 and the risk would be covered only from that date. In Daram Vir Anand’s case (supra), Supreme Court of India held as under:
“6. Having examined the rival submissions and having examined the policy of insurance ‘which is nothing but a contract between the parties and having considered the expressions used in Clause 4-B of the terms of policy we are persuaded to accept the submissions
