MUNISH MISHRA Vs. ORIENTAL INSURANCE CO LTD

JUDGEMENT

(1.) By the order impugned the Forum below has dismissed complaint of appellant seeking direction to respondent -the Oriental Insurance Company Ltd. to renew his Mediclaim Policy for the year 2002 -2003.

(2.) AS admitted by parties, the appellant had Mediclaim Policy from respondent -insurer for himself and for his family members including his wife for last 10 years. The last policy obtained by him was for the period from 9.8.2002 to 8.8.2003. During this period his wife suffered with cancer and his claim for reimbursement of medical expenses was also paid by the respondent -insurer. However, his prayer for renewal of the policy for the subsequent year 2003 -2004 was refused by the respondents and a cheque dated 4.8.2003 for Rs. 7553/ - remitted by appellant by post on 7.8.2003 to the respondent -Company was also returned by the latter. Although in its letter dated 11.8.2003 addressed to the appellant, the respondent -Company assigned no reason for not renewing the policy, but it was obvious that the renewal was refused as the appellant -complainant has already claimed the benefit under the policy in the preceding year and the ailment with which his wife suffered, was likely to continue for long and the expenditure could also be high.

(3.) IT is contended by Mr. Ravindra Tiwari, learned Counsel for the respondent -Company that it was a matter of contractual relationship and it was open for the respondent -Company to accept or refuse the proposal of the appellant. The question whether or not the refusal was justified, was wholly irrelevant. He placed reliance on a decision of this Commission rendered in Appeal No. 785/2003 Pramod Kumar Jain v. The Oriental Insurance Company Ltd., decided on 9.3.2004. As against it Mr. Atmaram Tank, learned Counsel for appellant vehemently contended that the respondent -Company having acquired status of the 'State' as envisaged under Article 12 of the Constitution, could not have acted in an unreasonable manner and refuse renewal merely because the appellant -insured had in the previous year obtained claim under the policy. We feel persuaded by the arguments of Mr. Tank. In fact, it is a case where the appellant and his family members have been paying premium for about 10 years. It was during previous year that the wife of the appellant was diagnosed suffering from cancer the treatment of which is likely to continue for long and expenditure could also be high. But if the Insurance Company at this juncture refuse to renew the policy, the appellant will be left in the lurch. Needless to say that if he goes to a new Insurance Company, his proposal is likely to be turned down or atleast the disease of his wife will be excluded from the insurance cover on the ground of it being pre -existing one. The very purpose of seeking insurance will be defeated. Surely the Insurance Companies are not expected to insure people under the belief that the insured is not likely to suffer any disease or else they would be free to refuse further insurance cover. If the Insurance Companies are allowed to refuse renewal in such cases, it would defeat the very object with which the General Insurance Business (Nationalisation) Act, 1972 was enacted and the whole concept of insurance will lose its meaning.