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VINOD S. BHARDWAJ
Oriental Insurance Company Limited – Appellant
Versus
Permanent Lok Adalat – Respondent
JUDGMENT
Vinod S. Bhardwaj J. (Oral)
The instant petition has been filed seeking quashing of the impugned award/order dated 21.04.2022 (Annexure P-1) passed by Permanent Lok Adalat (Public Utility Services), Gurugram, whereby the application filed by respondent No.2-claimant under Section 22 -C of the Legal Services Authorities Act, 1987 has been partly allowed and the petitioner-Insurance Company has been directed to pay an amount of Rs.60,000/- along with simple interest @ 6% per annum from the date of filing of the application till its realization along with Rs.5500/- as litigation expenses.
2. Briefly summarized, the facts of the present case are that husband of the respondent No.2-claimant had availed a Mediclaim policy bearing No.215301/48/2016/3895 for the period from 17.03.2016 to midnight of 16.03.2017 in the name of Amichand. The premium for the said policy was duly paid. The respondent No.2-applicant and her husband Amichand were insured under the said policy bearing No. MA-ID- 5022909716. However, on 09.01.2017, respondent No.2 fell on the floor in the washroom and sustained injuries. She was accordingly admitted in the Paras Hospital on 10.01.2017. Since respondent No.2
The burden of proof lies with the Insurance company to establish non-disclosure of material information, and suspicion alone is not sufficient to repudiate a claim.
In insurance contracts, the insured must disclose all material facts; failure to do so can lead to repudiation of claims under Section 45 of the Insurance Act, 1938.
Exclusion clauses in insurance contracts are binding unless proven unconscionable or contrary to public policy, reaffirming the validity of such clauses in commercial contracts.
There is nothing wrong in deciding the matter based on evidence adduced in the earlier round of litigation
The court established that conciliation proceedings under the Legal Services Authorities Act are mandatory, and failure to adhere to this process invalidates any resultant award.
The duty of the assured to make full disclosure of material facts in an insurance contract and the consequences of concealment or misstatement in obtaining insurance benefits.
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