INDER JIT SINGH
HDFC Ergo General Insurance Company Ltd. – Appellant
Versus
Rupkuwar Patel – Respondent
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 26.09.2019 of the State Consumer Disputes Redressal Commission, Chhattisgarh (hereinafter referred to as the ‘State Commission’), in First Appeal (FA) No. 18/645 in which order dated 21.05.2018 of District Consumer Disputes Redressal Forum, Raigarh (hereinafter referred to as District Forum) in Consumer Complaint (CC) No. 31/2018 was challenged, inter alia praying for setting aside the order dated 26.092019 passed by the State Commission and for dismissing the Complaint filed by Respondent-1/complainant before the District Forum.
2. While the Revision Petitioner (hereinafter also referred to as OP-3/Insurance Company) was Appellant before the State Commission and OP-3 before the District Forum and the Respondent-1 (hereinafter also referred to as Complainant) was Respondent-1 before the State Commission and Complainant before the District Forum and Respondent-2/HDFC Ltd. (hereinafter referred to as Bank) were Respondent-2 before the State Commission in FA/18/645 and OPs- 1 & 2 before the Distric
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Insurance Policy – Ambiguity in coverage clauses of disease – Repudiation of claim not justified.
Wrong Document – Petitioner/Insurance Company placed a wrong document before the District Forum and this Commission. Such an action is not expected from a public sector Insurance Company like the Pet....
Once there is a valid insurance policy available in favour of appellant, claim made by him for reimbursement of expenses incurred is justifiable and deserves to be paid to him.
Insurance Policy must be read holistically so as to give effect to reasonable expectations of all parties including insured & beneficiaries.
Medical Examination – Insurance company is responsible for conducting a medical examination of the policyholder in advance.
There should be nexus with pre-existing disease & disease for which claim has been made.
(1) National Commission - National Commission in exercise of its revisional jurisdiction Commission is not required to re-assess and re-appreciate the evidence on record.(2) National Commission - Nat....
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