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A. P. SAHI
Steel Authority of India – Appellant
Versus
National Insurance Company Ltd. – Respondent
ORDER
The complainant in order to extend medical benefits in general to all its retired employees under a Mediclaim Scheme 2014 invited bids, for which Request For Quotation (RFQ) was floated. The terms and conditions while inviting the bids were unambiguously framed giving the period of coverage from 01.01.2014 to 31.12.2014, followed by a right to the complainant to extend the same for a further period of 3 months upto 31.03.2015 on the same terms and conditions. This request was published on 14.11.2013 and the ultimate bid of the opposite party/National Insurance Co. Ltd. was accepted about which there is no dispute. The relevant Clause of the RFQ on the basis whereof the contract was finalized and accepted is extracted hereunder:
“The contract period of the intended scheme viz. the SAIL Mediclaim Scheme-2014 will be one year. The scheme shall come into effect from 01.01.2014 (0000 Hrs IST) and remain valid upto 31.12.2014 (2400 Hrs. IST). SAIL, however, reserves the right to extend the contract for a further period of 3-months up to 31.03.2015 (2400 Hrs. IST) on the same terms and conditions within the contract period.”
2. The terms and conditions under Clause-5 give a look out
(1) Oral Arguments cannot be accepted without there being any evidence led to the contrary.(2) Tender – Medical facilities – Insurance Company cannot unilaterally reduce OPD reimbursement rates.
Contract of insurance – Since the policy was held/renewed for 5 years, the plea of non-supply of terms and conditions is not tenable; the insured should have agitated this earlier.
Exclusion clauses in insurance contracts are binding unless proven unconscionable or contrary to public policy, reaffirming the validity of such clauses in commercial contracts.
Insurance Policy must be read holistically so as to give effect to reasonable expectations of all parties including insured & beneficiaries.
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