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NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION, NEW DELHI
Dr. Inder Jit Singh, Presiding Member
Rajendra Prasad Rai – Petitioner
versus
United India Insurance
Co. Ltd. and Ors. – Respondents
Revision Petition No.1934 of 2018
(Against the Order dated 26/03/2018 in Appeal No. 54/2017 of the State Commission Bihar)
Decided on 7.8.2023

Counsel for the Parties:
For the Petitioner:Mr. Krishna Dev Jagarlamudi and Mr. Inderdeep Kaur Raina, Advocates
For the Respondents:Mr. V.S. Chopra, Advocate

IMPORTANT POINT
Even if there is ambiguity, Consumer Protection Act being a beneficial legislation, it must be interpreted in favour of consumer.

Headnote:

Consumer Protection Act, 1986 – Section 21(b)[Consumer Protection Act, 2019 – Section 58] – Insurance – Personal Accident Policy – Injury in accident – Insurance Company closed case of Complainant as ‘no claim’ – Complaint allowed by Fora below – It is admitted by Complainant that he has been paid / offered settlement of claim for Rs.1.20 lacs along with medical expenses under extended medical benefit opted – If Complainant is to be given benefit of only one clause / sub clause, even though his case is covered under multiple clauses, he has right to get his claim which gives him higher benefit – OP Insurance Company must give him benefit with higher monetary benefit – Insurance Policy must be read holistically so as to give effect to reasonable expectations of all parties including insured and beneficiaries – It must be interpreted in a commercially sensible manner – Coverage clauses to be read broadly and ambiguity to be resolved in favour of insured – Exclusions to be read narrowly – OP shall pay amount of Rs.2.91 lacs under extended medical benefit to Complainant-Petitioner, instead of Rs.1.50 lakh awarded by State Commission/District Forum, along with 9% interest – Petitioner will also be entitled to litigation cost of Rs.30,000/-, including litigation cost of Rs.5000/- awarded by State Commission. (Paras 17, 18 and 19)

Result: Revision Petition partially allowed/disposed of.

ORDER

The present Revision Petition (RP) has been filed by the Petitioner against Respondents as detailed above, under Section 21(b) of Consumer Protection Act 1986, against the order dated 26.03.2018 of the State Consumer Disputes Redressal Commission Bihar (hereinafter referred to as the ‘State Commission’), in First Appeal (FA) No. 54 of 2017 in which order dated 17.01.2017 of District Consumer Disputes Redressal Forum Hajipur (hereinafter referred to as District Forum) in Consumer Complaint (CC) no 100 of 2014 was challenged, inter alia praying for allowing the RP by allowing the prayer of the Complainant/Petitioner as prayed in CC No. 100 of 2014 before the District Forum.

2. While the Revision Petitioner (hereinafter also referred to as Complainant) was Appellant and the Respondents (hereinafter also referred to as OPs were Respondents in the said FA No. 54 of 2017 before the State Commission, the Revision Petitioner was Complainant and Respondents were OPs before the District Commission in the CC no. 100 of 2014.

3. Notice was issued to the Respondents on 06.09.2018. Parties file their Written Arguments/Synopsis on 22.02.2023 and 28.06.2023 respectively. IA No. 16657 of 2018 seeking condonation of delay of 10 days in filing the RP is allowed on account of reasons stated therein.

4. Brief facts of the case, as emerged from the RP, Order of the State Commission, Order of the District Commission and other case records are that Complainant had taken Personal Accident Policy from the OPs in the year 1991-92 for insured amount of Rs.2,00,000/-. As per the terms of the policy, if a premium was paid within time every year, Rs.10,000/- was to be added in sum assured every year. The complainant continued paying the premium till 2004-06. On 25.05.2005, i.e. during the subsistence of the insurance policy, the complainant met with an accident and was admitted in the hospital. The said information was brought to the notice of the Opposite Party on 26.05.2005 and FIR was also lodged under section 342, 323, 324, 384, 307 and 34 of the IPC. The Petitioner vide his letter dated 25.08.2005 submitted the claim form with the Insurance Company. The complainant alleged that even though all the papers along with the claim form were submitted for action, the Insurance Company closed the case of the Complainant as ‘no claim’. He again resubmitted his papers and after sending reminders, legal notice, the Insurance Company sent a settlement intimation voucher asking him to receive R s.1,50,000/- as full and final payment. The Complainant protested this and on being protested, the opposite party informed him that since he had opted for Table-III of the policy, therefore, he is not entitled for an amount more than Rs.1,50,000/-. It is alleged by the complainant that he had opted for Table-IV of the policy and been paying the annual premium regarding the same. For this, the petitioner sought certain information from the Insurance Company and he was directed to deposit the cost for the same and the receipts were served upon him from which it was transpired that he had deposited the premium for Table IV option. The petitioner was served with one form in the year 1995-96 from which it transpired that his option for schedule IV filled up in the form was crossed and in the form itself it was written with full cover and inspite of this OPs tried to show that he had opted for Table-III. The Petitioner asked for other documents under RTI but the same were not supplied. He sent legal notice on 13.05.2009 and OPs replied on 16.06.2009 stating that his claim is not maintainable and sent intimation voucher. Petitioner alleged that OPs dishonestly and fraudulent manipulated option given by him for Table-IV by cutting the same and had written the word ‘Table-III’ in appropriate place. Being aggrieved, the petitioner initially approached the Hon’ble High Court

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