SHIVARAJ V.PATIL, V.N.KHARE
Biman Krishna Bose – Appellant
Versus
United India Insurance Company LTD. – Respondent
Appellant and his wife obtained a mediclaim policy in 1990; wife treated in 1991, claim of Rs. 8,243/- dishonored, leading to successful litigation up to Supreme Court in 1995 with costs of Rs. 20,000/-, but payment delayed requiring further proceedings. (!) (!)
Policy fell due for renewal; appellant applied timely on 24.1.1996 with cheque of Rs. 1,796/-, but insurer refused renewal on 7.3.1996 citing "past conduct" (prior litigation); writ petition succeeded in High Court, refusal set aside as unfair/arbitrary, but directed fresh policy as retrospective renewal not possible. (!) (!) [1000059810001]
Exclusion clauses (2.1, 2.1.14) bar coverage for pre-existing diseases in fresh policy; diseases during non-renewal period would be excluded, disadvantaging insured due to insurer's wrongful refusal. [1000059810001] (!) [1000059810008] (!)
Nationalized insurers (acquiring companies under General Insurance Business (Nationalisation) Act, 1972 ss. 3(a), 9, 24) hold monopoly, qualify as "State" under Art. 12, must act fairly/reasonably even in contracts; refusal based on insured's litigation for legitimate claim is arbitrary/irrelevant. [1000059810002]
Renewal extends original policy on same terms from expiration date; must be retrospective from due date to remedy harm from arbitrary refusal, preventing insurer exploiting exclusion clauses for diseases during lapse. [1000059810003][1000059810004]
Premium cheque returned; no correspondence during litigation, so no obligation to tender further premiums; insurer's argument rejected. [1000059810005]
High Court erred in directing fresh policy; set aside, insurer directed to renew expired period policy upon application and premium payment; appeal allowed with Rs. 5,000/- costs. [1000059810006][1000059810007] (!) (!)
JUDGMENT
V.N. Khare, J.-The appellant herein and his wife Smt. Alka Bose, took out a mediclaim insurance policy from the respondent United India Insurance Company (hereinafter referred to as insurance company ) on December 14, 1990. In July 1991, Smt. Alka Bose fell ill and as per advice of the doctor she was admitted to a hospital on August 14, 1991. She paid Rs. 8,243/- towards the charges for her treatment to the hospital. On August 30, 1991 the appellant lodged a claim for Rs.8,243/- with the insurance company along with necessary papers. Despite repeated requests the claim was not honored, with the result the appellant approached the District Consumer Grievance Redressal Forum (District Forum Calcutta) but the said complaint was rejected. On appeal before the State Commission, the order of the District Forum was set aside and direction was issued to the respondent insurance company to pay to the appellant a sum of Rs. 8,243/-. The insurance company thereafter went in revision before the National Consumer Redressal Commission which allowed the revision and set aside the order of the State Commission. Aggrieved, the appellant filed an appeal before this Court. On May 10,199
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