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VINOD S. BHARDWAJ
Bajaj Allianz General Insurance Company Ltd. – Appellant
Versus
Permanent Lok Adalat, Public Utility, Ludhiana – Respondent
JUDGMENT
Vinod S. Bhardwaj, J. (Oral)
Challenge in the present writ petition is to the award dated 26.10.2021 passed by the Permanent Lok Adalat (Public Utility Services), Ludhiana in Case Bearing No.29/2019 titled as 'Anuj Kumar Sehgal v. Bajaj Allianz General Insurance Company Limited'.
2. The undisputed facts that emerge from the pleadings are to the effect that respondent No.2-applicant/Anuj Kumar Sehgal had purchased a family health insurance Policy bearing No.OG191000602100035362 bearing customer ID No.123377999 valid w.e.f. 21.07.2018 to 20.07.2019 under which medical claim upto Rs. 5 lakh for respondent No.2-applicant/Anuj Kumar Sehgal and his wife Ms. Shabnam was covered. As per the case of respondent No.2-applicant/Anuj Kumar Sehgal, on 08.08.2018 when he was travelling to Gurugram along with his wife and relative Arun Sehgal, he suddenly felt acute abdominal pain and was immediately shifted to Shri. Ji Clinic Gurugram. The medical investigation was undertaken to rule out the possibility of Cardiac arrest. After a brief hospitalization and tests ruling out Cardiac issues, he was discharged. On his way back to Ludhiana, he felt the acute pain yet again and was taken to Adesh
Exclusion clauses in insurance policies are enforceable unless deemed unfair or against public policy, and consumers are presumed to accept terms if not disputed during the free look period.
Exclusion clauses in insurance contracts are binding unless proven unconscionable or contrary to public policy, reaffirming the validity of such clauses in commercial contracts.
Personal Accident Coverage under Motor Vehicle Policy is applicable to the insured, with the court affirming prior judgments supporting the claimants’ position.
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.
The main legal point established is that the insurance company is not liable to compensate if the deceased was under the influence of alcohol at the time of the accident, as per the terms of the poli....
A breach of essential terms of an insurance policy, such as using a private vehicle for hire, precludes the claimant from receiving benefits under the policy.
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.
Consumers are protected under the Act against negligent repudiation of claims by insurers, emphasizing careful consideration of the policy terms and conditions.
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