The judgment established the principle of protecting consumers with unequal bargaining power and emphasized the unfairness of exclusion clauses in standard form contracts.

JUDGMENT :

Arun Monga, J.

1. The writ petition is directed against the impugned Award dated 24.08.2009 (Annexure P-8) rendered by Permanent Lok Adalat, Hisar, whereby the complainant before it (respondent No.2 herein) was held entitled to an amount of Rs. 2,50,000/- in respect of the insurance policy purchased by him from the petitioner-company.

2. It would be apposite to set out brief factual background leading to the passing of Award and the filing of this writ petition. Vide an application dated 26.04.2005 (Annexure P2), the complainant applied for an insurance policy known as "Health First" from the petitioner company. At the time of selling the said insurance policy, the petitioner company/its agent only gave the application form/insurance cover note to the complainant. The insurance policy dated 30.04.2005 (Annexure P-3) containing the detailed terms and conditions, was issued and given to the complainant on a later date. The petitioner company states that in the said policy under the head note "General Provisions" expression "the Policy Contract" has been defined which, inter-alia, states as under :

"This contract is made in consideration of your application and payment of the require premium. The policy, application for it and any attached endorsements, constitute the entire contract. The terms and conditions of this policy cannot be changed or waived except by endorsement or rider duly signed by our duly authorized officer. The said policy under the heading "Basic Definitions" also, inter-alia, defines "covered illness, critical illness, covered injury, confinement and hospital etc." The said policy also specifically states under the Clause "Daily Hospital Benefit" as follows :

While this Policy is in force and during the lifetime of the insured, if the insured is admitted to a Hospital in India as an in-patient under the recommendation and professional care of a Registered Medical Practitioner for Medically necessary treatment of a covered injury or covered illness, we will pay the Daily Hospital Benefit for each day of confinement in the Hospital (except for the insured's first three (3) days of confinement) but not exceeding ninety (90) days for any one covered injury or covered illness in respect of the same confinement."

3. Xxx xxx xxx

4. The complainant got admitted in the hospital from 30.04.2006 to 02.05.2006 and had to undergo Angioplasty by adopting a procedure, which in medical terms is known as "CAG+PTCA to LAD RCA". After getting discharged from the hospital, the complainant applied for insurance claim vide intimation dated 30.05.2006 and the same was declined by the insurance company vide its letter dated 03.07.2006, inter-alia, stating as below :

"As per the terms and conditions of the contract, the said claim does not fall within the cover of the above policy :

It is not a confinement of more than 3 days in a pre-approved hospital.

From the medical information available, the condition suffered does not meet the criteria defined in the Critical illness benefit of the Health First Plan.

The operation/surgical procedure performed is not a condition covered under the Surgical Benefit.

We therefore regret to advise that there is no liability for the claim under the said contract."

5. In the aforesaid premise, the complainant approached the Permanent Lok Adalat by filing his complaint which lead to the passing of Award dated 24.08.2009 (Annexure P-8).

6. In the return filed by the complainant, dismissal of the writ petition has been sought on the ground that the petitioner company has not approached this Court with clean hands and has suppressed material facts from this Court.

7. I have heard rival contentions of learned counsel for the parties and have gone through the pleadings.

8. Learned counsel for the petitioner company essentially relies on the "Daily Hospital Benefit" policy clause ibid and submits that the same being a matter of contract between the insurer and the insured, the insured cannot wriggle out of the