IMPORTANT POINT
Insurance Company cannot resile from its liability after renewing policy from time to time.

By this Revision Petition, under Section 21(b) of the Consumer Protection Act, 1986 (for short “the Act”), National Insurance Company Ltd. (for short “the Insurance Company”), Opposite Party No.2 in the Complaint under the Act, calls in question the correctness and legality of the order dated 27.08.2009, passed by the State Consumer Disputes Redressal Commission, Delhi at New Delhi (for short “the State Commission”) in First Appeal No. 277 of 2009. By the impugned order, the State Commission has dismissed the Appeal in limine.

2. The Appeal had been filed by the Insurance Company against the order dated 03.02.2009, passed by the District Consumer Disputes Redressal Forum, New Delhi (for short “the District Forum”) in Complaint Case No.OC/1955/05, preferred by Respondents No. 1 and 2 herein. By the said order, while allowing the Complaint, alleging deficiency in service on the part of the Insurance Company in repudiating their claim under the Mediclaim policy, the District Forum had directed the Insurance Company to reimburse to the Complainants a sum of Rs.2,20,000/- and also pay a sum of Rs.5,00,000/- as compensation on account of deficiency in service and Rs.10,000/- towards litigation costs.

3. Succinctly put, the facts giving rise to the present Revision Petition, are: that the Complainants had obtained an Instant Health Care, Medical (Hospitalization) Risk policy, from the Insurance Company for the assured sum of Rs.5,00,000/-. The policy was valid from 25.07.2004 to 24.07.2005. The said policy was renewed on 11.08.2005 for the period from 25.07.2005 to 24.07.2006. Complainant No.2 is stated to have been taking regular treatment at Indraprastha Apollo Hospital as a case of End Stage Renal Disease. When she fell ill, she was admitted in the said Hospital for treatment. Pursuant to the pre-approval certificate issued to the Complainants on 05.11.2004 by Respondent No.3/Opposite Party No.1, namely, M/s E. Meditek Solutions Ltd., the Third Party Administrator (for short “the TPA”), for an amount not exceeding Rs.40,000/- and thereafter on 10.12.2004 and 16.12.2004 for an amount not exceeding Rs.6,500/- each, Complainant No.2 took the treatment from the Apollo Hospital. However, on 15.01.2005, the TPA issued a letter to the Medical Superintendent of the said Hospital, informing them that since the liability of the Insurer (Insurance Company) was not determinable at that point of time, cashless facility towards the treatment of Complainant No. 2 (Smt. Kamla Devi) could not be extended. They were advised to collect all the expenses from her and later on, she may send all the original documents to the TPA for reimbursement and her case would be decided on the basis of policy terms and conditions. On account of the said communication, the Complainants had to pay all the expenses on the treatment as charged by the Hospital for the treatment taken by Complainant No.2 from 19.01.2005. On 16.02.2005 Complainants submitted the documents to the TPA for reimbursement of the said expenses, which were not reimbursed. The Complainants got issued a legal notice, dated 28.05.2005, to the TPA, and prayed for reimbursement of medical expenses to the tune of Rs.2,20,000/- and restoration of cashless facility. Responding to the said notice, vide their letter dated 25.06.2005 the TPA not only contested the claims made therein, it asked Complainant No. 1 to return a sum of Rs.1,40,562/- paid by them to the Hospital on treatment of Complainant No. 2, as at the time of approving cashless facility, it was not disclosed to them that Complainant No. 2 was hospitalized in the year 2002 in Apollo Hospital with Thalesemia Minor, CEF with ESRD on MHD with severe anemia with Multiple Uterine Mymatosis and is a K ** Minor Thalesemia since 31.07.1999. In response thereto, vide their letter dated 06.07.2005, the Complainants, while disclosing the details of all the earlier mediclaim policies obtained by them right from 16.09.1999 and stating that they had no