NATIONAL INSURANCE CO.LTD. Vs. PUSHPA BANSAL

JUDGEMENT

(1.) This is an appeal received by transfer from Haryana State Consumer Disputes Redressal Commission against order of District Consumer Disputes Redressal Forum, Bhiwani (for short hereinafter to be referred as District Forum) dated 5.7.2001 in complaint case No. 345 of 1996, Sh. Rajinder Kumar Bansal and another v. National Insurance Company Limited and another.

(2.) Briefly stated the case of the complainants is that complainant No.1 got the medi -claim policy on 28.5.91 from OP No.1 through OP No. 2 because OP No. 2 is the agent of OP No. 1 This policy was valid for a period of one year from 28.5.91 to 27.5.92. Thereafter, the complainant renewed the policy every year and finally, it was renewed up to 27.5.96. The deceased complainant no.1 had submitted a medi -claim of Rs.59,000 to OP No.1. OP No. 2 came to the complainant and asked him to give illegal gratification of Rs.10,000. The complainant, however, did not agree and consequently, the medi -claim was passed only for a sum of Rs. 39,133. The complainant No.1 alleges that his claim was not passed in full due to a collusion between the OPs. It has further been alleged that the complainant No.1 sent and amount of Rs. 5,528 for the renewal of the medi -claim policy for a further period of one year i.e. from 28.5.96 to 27.5.97 but the same was not renewed and the cheque in question was returned by OP No.1 on the ground that the complainant No.1 had not sent the proposal form. The complainant No.1 was informed vide letter dated 4.6.96 by OP No.1 that the representative of the complainant had already obtained the proposal form whereas actually OP No.1 has refused to give the proposal form to his representative. Thereafter, the complainant wrote many letters to OP No.1 for the renewal of his medi -claim but nothing was done and finally vide letter dated 20.6.96, OP No.1 refused to renew the medi -claim policy. In the meantime, the complainant also filed an additional complaint demanding reimbursement of a medi -claim of Rs. 65,381 pertaining to the period 1996 to 1997. The complainants have, therefore, prayed that a direction be given to OP No.1 to renew the policy for the period from 28.5.96 to 27.5.97 and also to pay a compensation of Rs.1,00,000 for causing mental agony and physical harassment to complainant No.1 and further reimburse the full claim for the period 1995 -1996 and also the claim for the period of 1996 -1997 for which the policy was not renewed.

(3.) The version of OPs is that an amount of Rs. 39,133 was paid to the complainant towards full and final settlement. It has been admitted that the complainant No.1 had claimed a sum of Rs. 53,359.12 ps in respect of injury sustained by him in an accident and out of this amount, a sum of Rs.11,000 was claimed towards the bill for the treatment of diabetes and hypertension, which was not payable as per the terms and conditions of the policy. Further, a sum of Rs. 3,126 had been claimed on account of X -ray charges, ECG charges and medical kitchen charges etc., which were also not payable and hence, a claim of Rs.39,133 was found payable and the same was paid to complainant No.1. It is further the case of OPs that the National Insurance Company Limited decided not to renew the policy of deceased complainant No.1 w.e.f. 27.5.96 onwards after considering the entire circumstances and taking into consideration the fact that there was no mention by the complainant No.1 in the proposal form about the ailment of diabetes and after considering this nondisclosure and past experience with the complainant No.1, the medi -claim policy was not renewed. It has been further emphasized that the medi -claim policy is renewed by mutual consent and as such, OP No.1 was not bound to renew the policy.