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SUBHASH CHANDRA, J. RAJENDRA
Omprakash Khandelwal – Appellant
Versus
Oriental Insurance Company Limited – Respondent
ORDER
AVM J. Rajendra, AVSM, VSM (Retd.), Member—This Revision Petition is filed under Section 21(b) of the Consumer Protection Act, 1986 (the “Act”) against the Chhattisgarh State Consumer Disputes Redressal Commission, Raipur, (‘the State Commission’) order dated 24.08.2016 in FA No. 224/2016 allowing the Appeal filed by the Respondent/OP against order dated 07.04.2016 passed by the District Consumer Disputes Redressal Forum, Durg (‘District Forum’) which allowed the complaint.
2. As per the office report, there is 119 days delay in filing this Revision Petition. For the reasons stated in I.A. No.19028 of 2017, the delay is condoned.
3. For convenience, the parties are referred to as placed in the original Complaint filed before the District Forum.
4. Brief facts of the case, as per the complainant, are that he obtained an individual medi-claim policy for himself and his wife starting in 2011-12, which has been renewed annually and was active for the period 2014-15 with a sum insured of Rs.3,00,000. On 12.04.2014, the complainant was admitted to Jupiter Hospital due to heart-related ailments and underwent coronary angioplasty and other treatments, incurring medical expenses of Rs.
(1) Insurance – A contract of insurance is one of utmost good faith. (2) Proposer – Proposer who seeks to obtain a policy of life insurance is duty bound to disclose all material facts bearing upon t....
Contract of Insurance – A contract of insurance is one of utmost good faith. A proposer who seeks to obtain a policy of life insurance is duty bound to disclose all material facts bearing upon the is....
There should be nexus with pre-existing disease & disease for which claim has been made.
Insurance Policy must be read holistically so as to give effect to reasonable expectations of all parties including insured & beneficiaries.
(1) Full Knowledge – DLA had the full knowledge of pre-existing ailments at the time of filling the proposal form and there was a nexus with preexisting disease and the cause(s) of death.(2) Proposal....
(1) Proposal form – In filling up the proposal form, the agent normally, ceases to act as agent of the insurer but becomes the agent of the insured and no agent can be assumed to have authority from ....
Revisional Jurisdiction – Revisional jurisdiction of the National Commission is extremely limited, it should be exercised only in case as contemplated within the parameters specified in the provision....
Point of Law : No fault can be found with the repudiation and the order of Ombudsman affirming the said repudiation and disallowing the claim. [Para 13]
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