IMPORTANT POINT
The issue whether the Complainant is entitled for compensation for the losses of license of its employees from the Respondent/OP-Insurance Company, and if so, the determination of the amount is not a matter for adjudication by National Commission.

ORDER

The present First Appeal has been filed under Section 19 of the Consumer Protection Act, 1986 (“the Act”) against the Order dated 11.04.2019 passed by the State Consumer Disputes Redressal Commission, Delhi, (“the State Commission”), in CC No. 138/2015, wherein the Complaint of the Complainant (Appellant) was dismissed.

2. For convenience, the parties involved in this Appeal will be referred as per their position in the Complaint originally filed before the Ld. State Commission. The Complainant/Appellant, “Pawan Hans Ltd.” is a Mini-Ratna Govt. of India Enterprises, provides helicopter services to both Govt. and Private sector companies to cover areas such as oil rigs, mines, jungles etc and the “New India Assurance Company Ltd. is the Opposite Party/Respondent or the insurer (OP).

3. Brief facts of the case, as per the Complainant, are that the Complainant secured a “Group Insurance Policy LOL (Loss of License Policy)” from the Opposite Party (OP) for its 152 pilots, with coverage set at Rs. 30 lakhs for pilots under 55 years of age and Rs. 24 lakhs for pilots aged 55 to 65. Previously, the policy was obtained from 01.04.2012, to 31.03.2013. Subsequently, a tender was floated for the period from 01.04.2013, to 31.03.2014 to the OP and three other PSU Insurance Companies, namely New India Assurance Company Ltd., Oriental Insurance Company, National Insurance Company, and United India Insurance. The OP submitted a tender on 19.03.2013, for the renewal of the policy, providing premium rates without specifying any conditions. As per the Complainant’s employment terms, every recruited pilot is entitled to a PA Aircrew insurance policy and a loss of license (LOL) policy while serving in the company. The validity and continuity of the pilot’s license, issued by the Directorate General of Civil Aviation (DGCA), hinge upon the pilots’ physical and mental medical fitness. The OP Insurance Company secured the tenders for the year 2014-15, with the premium paid by the Complainant to the OP being approximately Rs. 20 lakhs annually, considerably higher than the premiums paid by pilots under their individual policies.

4. During the year 2012-13, a claim was made for loss of license of Capt. Indu Kumar Kanwar for permanent disablement due to illnesses. The claim amount was Rs. 24 Lakhs, and the OP settled it for Rs. 18 Lakhs, without objection. Subsequently, during the period from 01.04.2013, to 31.03.2014, four pilots suffered total or partial disablement due to illnesses. Their claims totalling Rs. 80 lakhs were filed with the OP. However, all four claims were repudiated by the OP, citing that the pilots had already taken individual policies from other insurance companies and therefore are not entitled to this claim, under Clause/Condition no.2 under the heading ‘exclusion’ reads as follows:-

“Notwithstanding anything to the contrary contained in this Policy no liability shall attach to the company to the extent to which the insured and insured persons is also entitled to benefit under any other policy of insurance insuring the insured person against any of the risks hereby insured, (other than any personal accident insurance), unless written notice of the existence of that other policy shall have been given to the company and the company’s acquiescence has been noticed by the endorsement hereon.”

5. The Complainant alleged that the OP’s rejection was unjustified, as the terms and conditions outlined in the individual policies obtained by the four pilots explicitly stated that the policies would remain valid even if a group policy had been procured by the employer. Capt. Mahajan and Capt. Shukla had acquired policies from United India Insurance Company Ltd., while Capt. Mahal and Capt. Ramani had policies from Bajaj Allianz. The rejection of the claim by the OP was mere pretext for avoiding the settlement of legitimate claims of the pilots, especially considering that no such queries or objections were raised by the OP in 2012-13