Bajaj Allianz General Insurance Company Limited VS Surinder Pal Singh

Judicial Analysis Court Copy Headnote Facts Arguments Court observation

NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION, NEW DELHI
Sudip Ahluwalia, Presiding Member
Bajaj Allianz General Insurance
Company Limited – Appellant(s)
versus
Surinder Pal Singh – Respondent
First Appeal No.360 of 2017
(Against the Order dated 18/10/2016 in Complaint No. 01/2014 of the State Commission Punjab)
Decided on 8.11.2023

Counsel for the Parties:
For the Appellant:Mr. Ankit Chaturvedi and Mr. Abhinav Goswami, Advocates
For the Respondent:Mr. Sukant Vikram, Advocate

Headnote:
Consumer Protection Act, 1986 – Section 19 [Consumer Protection Act, 2019 – Section 51] – Services – Insurance – Repudiation of claim – Commission finds no impropriety in the view taken by the Ld. State Commission of having drawn an adverse inference against the Appellant/Insurance Company for having failed to produce the Proposal Form in the face of specific denial of the same having been signed by the Complainant-Insured, and his challenge to have the authenticity of his purported signatures to be examined by a handwriting Expert to know the truth. It is also the contention of the Respondent/Complainant that even in the disputed first page of the Proposal Form (which in any case had not been filed by the Appellant but was placed before the State Commission as Exh. R6), there was no question of any concealment on the part of the alleged Proposer since no questions pertaining to any specific disease or any material particulars were contained in the relevant column, and actually all the concerned columns were found to have been only left ‘blank’ without any endorsement of either “Yes or No”, or “Not applicable” – Consequently, the Appeal was finally allowed by the Hon’ble Supreme Court against the Insurance Company which was directed to indemnify the Complainant/Appellant for the expenses incurred by him towards medical treatment covered under the Policy – Appeal dismissed. [Paras 8 to 16].
Result: Appeal dismissed.

ORDER

Sudip Ahluwalia, Member—The present Appeal under Section 19 of the Consumer Protection Act, 1986 has been filed by the Appellant/Insurance Company against the impugned Order dated 18.10.2016 passed by the State Consumer Disputes Redressal Commission, Punjab, Chandigarh in Consumer Complaint No. 01 of 2014 vide which, the Complaint filed by the Respondent/Complainant was allowed.

2. Brief facts of the case as per the Complaint are that the Complainant was having a manufacturing Unit at Ludhiana dealing with farm equipment. He regularly visited other countries for business purposes. A Farm Progress Show i.e. Western Canadian Farm Progress show was organised in Regina, Saskatchewan, Canada from 13.06.2011 to 18.06.2011. Thirteen members of Indian Business Delegation were invited by the Canadian Trade Commission Service, including the Complainant. It was mandatory for a person traveling abroad to obtain travel insurance before departure from the home country. The Complainant had obtained travel insurance from the Appellant by paying a premium of Rs. 2002/-, and he was issued Policy No. OG-12-1203-9910-00000296 on 31.05.2011. At the time of the issuance of the Policy, no one from the side of the Appellant met the Complainant and no terms and conditions were explained to him. The Insurance Policies of all the delegation members were supplied at a particular place after collecting premium from all the members of the delegation. During the visit, on 15.06.2011, the Complainant suffered chest pain and he was admitted at General Hospital Regina in the emergency ward. He was then given treatment for emergent Cardiac Catherization and was discharged on 28.06.2011. At the time of discharge, the Complainant was not given any bill and he was informed that the bills would be recovered from his cashless Insurance Policy, and so he was not required to make any payment. However, in March 2012, the Complainant received a bill of $43,940/- issued by Regina Hospital Canada with comments that the Hospital was not responsible for sending invoices to Insurance Companies and that the same was the responsibility of the Complainant. The Complainant then approached the Insurance Company for clearing the bill and he was assured that the bills would be cleared soon but there was no action on the part of the Insurance Company. The Complainant then received letters from OVAG International, vide which demands were raised to make immediate payment. The Complainant later received a repudiation letter dated 23.09.2013 at his Email which stated that the claim was repudiated as he was taking medications for ‘Hyperlipidaemia’ disorder for the past 15 years, and that he also had allergy for aspirin tablet. It was further stated that the Complainant was suffering from Hypertension as well for the past 5 years and this was pre-existing in nature which was not declared at the time of filing the Proposal Form. It is the case of the Complaint that the Insurance Company has wrongfully repudiated the claim. Aggrieved by the acts of the Insurance Policy, the Complainant filed a Complaint before the State Commission, Punjab, Chandigarh.

3. The State Commission vide its Order dated 18.10.2016 allowed the Complaint. The relevant extracts of the Order of the State Commission are set out as below—

“13. For the reason recorded above, complaint filed by the complainant is accepted and OPs are directed to pay the amount of medical expenses incurred by, the complainant on his ailment in Canada within 45 days from the receipt of copy of this order. The OPs shall also pay compensation of Rs. 50,000/- to complainant for mental harassment and Rs. 15,000/- as costs of litigation.”

4. Aggrieved by the Order of the State Commission, the Appellant filed the present Appeal raising the following issues—

(a) That the State Commission failed to appreciate the fact that the said Policy itself contained a categorical declaration by the Respondent that he was aware that the said Policy did