2006 Supreme(All) 3101
[2007(1) ADJ 11 (DB)]
ALLAHABAD HIGH COURT
BEFORE : R.K. AGRAWAL AND VIKRAM NATH, JJ.
UMESH NARAIN SHARMA ——Petitioner
Versus
NEW INDIA ASSURANCE CO. LTD. AND OTHERS ——Respondents
(Civil Misc. Writ Petition No. 61244 of 2005, decided on 27th November, 2006)
Suneet Kumar for the Petitioner; A.B. Saran, Paramatma Rai for the Respondents.
Headnote:Insurance policy—Medi-Claim Insurance policy—Petitioner had taken from respondent-Insurance Co., a sum of Rs. 2 lacs—His claim of Rs. 3.31 lacs was rejected by respondent-Co.—Writ Petition against—Held, instant case was not a case simpliciter for enforcing contractual right—But challenges arbitrary action of Insurance Co., which was covered under Article 12 of Constitution, in rejecting claim of petitioner on wholly untenable grounds—And, therefore, rejecting his claim was quashed—Respondent-Co. directed to process claim of petitioners—And make payment of amount, which was found due and payable to petitioner—Hence, petition allowed with a costs of Rs. 5,000/- payable to petitioner. [Contract Act, 1872—Section 23; Constitution of India—Article 12]. [Paras 14 and 17]
Hon’ble R.K. Agrawal, J.—By means of the present writ petition filed under Article 226 of the Constitution of India, the petitioner, Sri Umesh Narain Sharma, seeks the following reliefs :
“(i) issue a writ, order or direction in the nature of certiorari quashing the order dated 13.6.2005 issued by the respondent No. 2 (Annexure 1 to the writ petition);
(ii) issue a writ, order or direction in the nature of mandamus commanding upon the respondents to pay the claim of Rs. 3.31 lacs to the petitioner in respect of the expenses incurred in the treatment of the petitioner;
(iii) issue any other suitable writ, order or direction which this Hon’ble Court may deem fit and proper and to which the petitioner may be found entitled to in the facts and circumstances of the case;
(iv) award costs of this petition to the petitioner.”
2. Briefly stated, the facts giving rise to the present petition are as follows :
The petitioner is a Senior Advocate of this Court. He had taken a medi claim insurance policy from the New India Assurance Company Limited, Allahabad, respondent No. 3, which is a subsidiary of the General Insurance Corporation of India. It is a Government Company wholly managed and controlled by the Government of India. According to the petitioner, he was insured by the respondent No. 1 for the first time on 24.11.1998. It was renewed from time to time and except for some break in renewal during the year 1999 and 2000, the mediclaim insurance policy had been in force continuously for the last 5 years since 30.1.2001. The particulars of the policy, period of insurance and also the claim, if any, preferred by the petitioner is given below :
Policy No. Period of Insurance Claim made
4208014807021 24.11.1998 to 23.11.1999 NIL
4208014807955 17.01.2000 to 16.01.2001 NIL
4208014808652 30.01.2001 to 29.01.2002 NIL
4208014809832 30.01.2002 to 29.01.2003 NIL
4208014800509 30.01.2003 to 29.01.2004 NIL
4208014800915 30.01.2004 to 29.01.2005 NIL
4208014875129 30.01.2005 to 29.01.2006 Claim in question
3.The mediclaim insurance policy taken by the petitioner was for a sum of Rs. 2/- lacs. According to the petitioner, while getting himself insured, he had disclosed all material facts as required by the Insurance Company, including the details of his health condition and at the time of taking the mediclaim insurance policy on 24.11.1998, he did not suffer from any ailments or heart disease nor did he had any symptom of any cardiac problem. In the first week of March, 2005, the petitioner had some complaint regarding his health and on medical advice, he got himself checked up and was admitted on 18.3.2005 at Kailash Heart Institute, H-33, Sector-27, NOIDA for treatment of heart disease under Dr. D.S. Gambhir, M.D., D.H., F.A.M.S. The petitioner underwent angiography in which it was found that there was blockade in the arteries. The petitioner was advised for angioplasty which he underwent and was discharged from the hospital on 22.3.2005. The petitioner made a claim for reimbursement of the medical expenses for a sum of Rs. 3.31 lacs which he had incurred on account of treatment of his disease and hospitalisation, by submitting the claim form dated 23.3.2005. The respondent No. 1 verified the claim and vide letter dated 13.6.2005 rejected the claim on the following grounds :
“It is noted from the insurance certificate that there was a break in policy while renewal in 2001. The patient is a known case of CAD since 2005 (5 years). Hence the disease is pre-existing and the claim is not payable.”
4. The rejection of the claim is under challenge in the present writ petition on the ground that the stand taken by the Insurance Company is arbitrary; that the petitioner had been insured with the respondent No. 1 with effect from 24.11.1998 and since then the mediclaim insurance policy is continuing; the break in the continuity of the policy for 13 days, i.e., from 17.1.2001 to 29.1.2001 would have no material bearing and as the Insurance Company had conti