ORIENTAL INSURANCE COMPANY LTD Vs. K ANANDAM

JUDGEMENT

(1.) The short issue to be decided in this case is whether lapsed (due to dishonouring of the cheque issued by the insured) medi-claim policy which was renewed (after payment of the insurance premium in cash) after a gap of 9 days could be construed as a fresh policy or continuation of the existing policy.

(2.) The simple answer to this question is that the policy issued after 9 days of lapse becomes a fresh policy with the fresh terms and conditions as the discontinuance was due to the lapse on the part of the insured. Brief facts of the case :

(3.) The complainant Shri K. Anandam availed medi-claim insurance policy from the Oriental Insurance Company for the first time for the period from 13.1.2001 to 12.1.2002 by paying a sum of Rs. 14,099 as premium. He continued the policy by payment of premium for the next year which was valid until 12.1.2003. For renewal of the policy for subsequent year commencing from 13.1.2003 the complainant issued a cheque towards premium which was dishonoured. Thereafter, the policy was renewed for an year from 21.1.2003 to 20.1.2004 on receipt of premium by cash. It is the say of the complainant that unfortunately he suddenly developed chest pain and underwent by-pass surgery on 30.1.2003 at Narayana Hrudalaya, Bangalore. The Insurance Company was kept informed of the same by the daughter of the complainant. The claim for Rs. 1,60,000 spent towards medical treatment was dishonoured by the Insurance Company on flimsy grounds. Accordingly, the complainant filed a complaint before the District Forum to direct Insurance Company to reimburse a sum of Rs. 1,60,000 along with Rs. 50,000 towards compensation and cost. The District Forum after going through the records of the case, evidence led by the parties and hearing the Counsel for the parties held that the opposite party/Insurance Company was deficient in rendering services to the complainant and, therefore, it directed the OP to reconsider the claim application. It further held that "If the claim application is to be allowed on merits, the amount to be reimbursed shall carry interest at 18% p.a. from the date of the claim application till payment. The OP in the circumstances shall pay a sum of Rs. 2,000 (Rupees two thousand only) to the complainant towards the costs incurred by the complainant in this proceeding.