NEW INDIA ASSURANCE CO Vs. KUSUM KUMARI MANDHGHORIA

JUDGEMENT

(1.) This is an appeal against the judgment and order passed by the learned District Forum, Howarh in Case No.71 of 2003 on 21.10.2003. The case in brief is that one Mr. Shib Bhagwan Madhogaria obtained a mediclaim insurance policy from New India Assurance Co. Ltd. He was admitted to Apollo Hospital and Jaslok Hospital and Research Centre at Mumbai for treatment. He preferred a claim of Rs.74,674.35 with the appellant for reimbursement of medical bills for his treatment at the above hospital. The claim was settled after several inquiries and repeated reminders on 2.5.2003.

(2.) The said policy was due to expire on 31.3.2003. But in the meantime there had been a hike in the insurance premium but the same was not communicated to the policy holder. The policy holder sent a cheque of Rs.4,349 to the appellant -Co. in god faith on 21.3.2003 for renewal of the mediclaim policy. But the appellant returned his cheque on 24.3.2003 which was received by him on 31.3.2003 i. e. , after the expiry of the said policy. Immediately thereafter the policy holder sent another fresh cheque of Rs.4,610 towards insurance premium after he was intimated that the insurance premium had been hiked. The said cheque was sent on 31.3.2003 to the Calcutta Divisional Office of the appellant. But the appellant again refused to accept the cheque and returned the same advising the insured to send it by post. Accordingly the insured sent it by post on 3.4.2003 but the cheque was again returned on the plea that the policy had expired on 28.3.2003 and the appellant-Co. asked for a fresh proposal.

(3.) The insured thereafter filed a complaint before the Howrah District Forum for issuing direction on the appellant-Co. to revive the mediclaim policy and for accepting cheque of Rs.4,610 from the insurer and also for payment of compensation of Rs.1,00,000 for the harassment and mental agony. The O. P. contested the case by filing a written version. The appellant, however, contended that the complainant had ceased to be a consumer within the meaning of Sec.2 (d) (1) of the C. P. Act, 1986 after expiry of the policy on 31.3.2003 and since there was no contract between the complainant and the Insurance Co. as on that date the complaint should fail. The contention of the appellant-Insurance Co. came under scrutiny of the Forum. The learned Forum observed that prima facie there was no failure on the part of the complainant to maintain continuity of the policy and for this purpose he had sent the cheque of Rs.4,349 which was returned by the appellant Co. allegedly with a mala fide intention to deprive him of the rights and privileges of continuity. The appellant-Co. even returned his cheque of Rs.4,610 which he had sent as per revised premium amount. Thus due to obstinate stand taken by the appellant-Insurance Company continuity of his policy was broken and he had been forced to ask for a new policy.