w w w . L a w y e r S e r v i c e s . i n



Life Insurance Corporation of India Through Its Zonal Manager, Life Insurance Corporation Of India, New Delhi v/s Rajendra Sudamrao Shinde & Another


Company & Directors' Information:- RAJENDRA LIMITED [Strike Off] CIN = U99999KA1943PLC000306

Company & Directors' Information:- NEW INDIA CORPORATION PRIVATE LIMITED [Strike Off] CIN = U36999TN1940PTC001776

Company & Directors' Information:- I.N. INSURANCE COMPANY PRIVATE LIMITED [Strike Off] CIN = U67200DL1994PTC062554

Company & Directors' Information:- INSURANCE OF INDIA LTD [Strike Off] CIN = U67200WB1936PLC008634

    Revision Petition No. 2529 of 2019

    Decided On, 13 February 2020

    At, National Consumer Disputes Redressal Commission NCDRC

    By, THE HONOURABLE DR. S.M. KANTIKAR
    By, PRESIDING MEMBER

    For the Petitioner: Meghna Sankhla, Advocate. For the Respondents: ----------



Judgment Text


1. The revision petition has been filed under Section 21(b) of The Consumer Protection Act, 1986, hereinafter referred to as the ‘Act’, challenging the Order dated 22.08.2019 of the Maharashtra State Consumer Disputes Redressal Commission, Mumbai hereinafter referred to as the ‘State Commission’.

2. Brief facts relevant for the disposal of the case are that the complainants, alongwith their two children, had taken a policy (Policy No. 925914442) from the OP under Health Protection Plus Plan. The sum assured was Rs. 2,00,000/- each. Four premiums amounting to Rs. 1,00,000/- was paid by the complainants. As per the policy in question, the complainants and their children were entitled for re-imbursement of medical expenses and expenses for surgery amounting to RS. 2,00,000/- each. Thereafter, the complainant no. 2 underwent a surgery for breast cancer and incurred an expense of Rs. 1,85,000/-. The complainants submitted a claim to the OP for the same. To this, the OP sent a letter sanctioning only Rs. 2,300/- stating the reason that medical expenses could not be sanctioned. Later, vide letter dated 30.10.2015, the OP repudiated the claim stating that entire hospital expenses could not be reimbursed as the policy was a Fixed Benefit Policy and not a medi-claim policy. Being aggrieved, the complainant filed a complaint in the District Forum.

3. The complaint was resisted by the OP by filing a written statement. It was contended that the policy was issued under Plan No. 902 and the terms and conditions were explained to the complainant. The policy in question was issued with the consent of the complainant. The complainants were only entitled to hospitalization expenses as per the terms and conditions. So, an amount of Rs. 2,300/- is sanctioned by the OP.

4. The District Forum, vide order dated 25.10.2017, partly allowed the complaint. It directed the OP to pay Rs. 1,83,466/- to the complainant being the expenses incurred for the surgery with interest @ 9 % p.a. till the said amount is paid to her. Compensation of Rs. 90,000/- towards physical and mental harassment and Rs. 5,000 towards cost of complaint was ordered to be paid by the OP to the complainant. It observed the following:

7. On sr.no.3/2 the complainant has produced copy of Health Protection Plus policy no. 925914442. Upon perusal of the said policy it is observed that the same is valid up-to 31/03/2032. Particulars of insurance cover are defined in the policy. It is mentioned under clause no. 3 thereof that – Daily Benefits (H.C.B.) Hospital Cash Benefit is available to complainant no. 1 and 2 and their two children @ Rs. 1,000/- each . As per cl. No. 4- (M.S.B.) Major Surgical Benefits Sum Assured is available @ Rs. 2,00,000/- each – to complainant no. 1 and 2 and their two children. Hence, as per the said policy, the complainant is entitled to receive the said Surgical benefit. It is not denied that complainants have paid the premiums @ Rs.25,000/- continuously for four years totaling to Rs. 1,00,000/- . OP has issued only cover note of the policy. As contended by the OP and as mentioned therein the policy is issued under Plan No. 902. But it is not seen that the terms and conditions of the said plan have been provided to the complainants. It appears that only cover note of the policy is provided to the complainants. The complainant has not produced copy of terms and conditions of the policy. But OP has produced terms and conditions of Plan no. 902. Surgical Benefit Annexure is annexed to the terms and conditions of policy. An annexure showing charges payable in each type of surgery is also annexed. The surgery for cancer cyst is not included in the said annexure. Therefore, according to OP the expenses claimed by complainants are not payable as per policy terms and conditions. The said fact has been mentioned in OP’s written statement. While repudiating the claim the OP has not stated that the claim is repudiated as it comes under Exclusion Clause. Hence, it can be said that the repudiation of claim is an after thought. It is not clearly mentioned in the Exclusion Clause of policy that the Benefit is not payable in case of cyst of cancer. Further, the OP has not contended that the said ailment was pre- existing.

Most importantly, the complainant has filled in the proposal form under Plan no. 901. OP has committed an error in issuing policy under Plan no. 902 whereas the proposal form is submitted under Plan no. 901. OP has not explained as to what are the terms and conditions of Plan no. 901. It is clear that the OP has suppressed this material fact. OP has issued policy under Plan no. 902 to the complainant. It is clearly stated therein that the Surgical benefit of Rs. 2,00,000/- can be allowed. Hence, the Forum is of the opinion that OP has committed deficiency in service in repudiating the claim of the complainants. While submitting the claim forms the complainant has attached bills amounting to Rs. 1,83,466/-. Complainant has also produced copy of Doctors certificate of surgery. Hence, the Forum is of the opinion that the complainants are entitled to recover insurance claim of Rs. 1,83,466/- @ 9 % p.a. interest .

- - -

(emphasis supplied)

5. Being aggrieved by the order of the District Forum, the OP approached the State Commission. The State Commission vide its order dated 22.08.2019, dismissed the appeal with Rs. 10,000/- as cost of litigation to be paid by the OP to the complainant. It observed:

6. - - - There is no evidence on record about the “Informed acceptance” of the terms and conditions by the insured and that the policy holder was knowing the details about the policy and benefits available under this policy.

7. We are of the considered opinion that selling the products of insurance to consumers in different names with terms of conditions that will pay less to the consumer , not giving the information to the consumer about that the policy may fetch less benefits as per the terms, not explaining the policy terms to the consumers in their own language and not seeking the “Informed acceptance” of the policy terms and conditions by consumers constitutes “Unfair Trade Practice” by the insurance company.

- - -.

6. Being aggrieved by the abovesaid order of the State Commission, the OP approached this Commission.

The cardinal doctrine applied in a contract of insurance is ‘uberrimae fides’ (utmost good faith). This kind of contract requires highest standard of good faith while material facts are disclosed as this would influence the decision of the other party. In the present case, the complainants took the policy only with the intention that their family would be reimbursed in case they incur any expense due to ill health. The complainants took the policy under the guidance of the agent. It is the responsibility of the OP to give a clear picture of the policy to the intending purchasers. The OP failed to do so. This certainly amounts to ‘deficiency in service’ as well as ‘unfair trade practice’ on the part of the OP.

7. I find the Order of the State Commission to be well-appraised and well-reasoned. The State Commission concurred with the findings of the District Forum. Within the meaning and scope of section 21(b), I find no grave error in ap

Please Login To View The Full Judgment!

preciating the evidence by the two fora below, as may cause to require re-appreciation of the evidence in revision. I note in particular the extracts of the respective appraisals made by the two fora quoted, verbatim, in paras 4 and 5 above. I find the award made by the District Forum (quoted in para 4 above), and as affirmed by the State Commission, to be just and appropriate. And, on the face of it, I find no jurisdictional error, or a legal principle ignored, or miscarriage of justice. 8. The revision petition, being misconceived and devoid of merit, is dismissed. 9. Needless to add that the District Forum shall undertake execution of its Order as per the law. 10. A copy each of this Order be sent to the District Forum and to the complainant by the Registry within ten days.
O R







Judgements of Similar Parties

04-08-2020 Regional Manager, Bajaj Allianz General Ins. Co. Ltd., New Delhi & Another Versus Capt. Bibhuti Mohan Jha National Consumer Disputes Redressal Commission NCDRC
04-08-2020 Kaizen Organics Pvt. Ltd., Jaipur Versus National Insurance Co. Ltd. & Another National Consumer Disputes Redressal Commission NCDRC
31-07-2020 National Insurance Co. Ltd. Through Rajesh Kumar Dy. Manager, New Delhi Versus Biking Food Products (P) Ltd., Telangana National Consumer Disputes Redressal Commission NCDRC
30-07-2020 Som Nath Bhatt Versus Central Provident Fund Commissioner, New Delhi & Another National Consumer Disputes Redressal Commission NCDRC
30-07-2020 Som Nath Bhatt Versus Central Provident Fund Commissioner, New Delhi & Another National Consumer Disputes Redressal Commission NCDRC
29-07-2020 New Aadinath Plywood & Hardware Through Its Proprietor, Shri Sanjay, M.P. Versus Nandini Photo Studio, M.P. National Consumer Disputes Redressal Commission NCDRC
28-07-2020 M/s. Royal Sundaram Alliance General Insurance Co.Ltd., Rep.by its Branch Manager, Cantonment Versus Kaanikkaimery & Others High Court of Judicature at Madras
27-07-2020 Amar Chand Singh Versus C.B.I. Thru. Director, New Delhi & Others High Court Of Judicature At Allahabad Lucknow Bench
27-07-2020 Tata AIG Life Insurance Co. Ltd., Maharashtra Versus Mampi Dhar (Gosh) & Another National Consumer Disputes Redressal Commission NCDRC
27-07-2020 IFFCO Tokio General Insurance Co. Ltd., Maharashtra Versus Ashok Laxman Mane & Others National Consumer Disputes Redressal Commission NCDRC
27-07-2020 Oriental Insurance Co. Ltd. Through Its Duly Constituted Attorney, Oriental Insurance Co. Ltd., New Delhi Versus Vikash Kumar National Consumer Disputes Redressal Commission NCDRC
24-07-2020 Gurbax Singh Banga Versus Aviva Life Insurance Co. India Pvt. Ltd., Punjab & Others National Consumer Disputes Redressal Commission NCDRC
24-07-2020 National Insurance Company Limited Through Its Duly Constituted Attorney Manager, New Delhi Versus M/s. D.D Spinners Pvt. Ltd., Panipat National Consumer Disputes Redressal Commission NCDRC
24-07-2020 Hindustan Insecticides Ltd., Through Its Authorized Representative, New Delhi Versus Thakar & Others National Consumer Disputes Redressal Commission NCDRC
22-07-2020 Director of Income Tax-II (International Taxation) New Delhi & Another Versus M/s. Samsung Heavy Industries Co. Ltd. Supreme Court of India
22-07-2020 M/s. TDI Infrastructure Ltd. (Through Its Authorised Representative), New Delhi Versus Sukhmal Jain & Another National Consumer Disputes Redressal Commission NCDRC
22-07-2020 Reliance Nippon Life Insurance Co. Ltd., Maharashtra Versus Sujoy Chatterjee National Consumer Disputes Redressal Commission NCDRC
21-07-2020 SBI Life Insurance Co. Ltd., West Bengal Versus Kajari Gayen & Another National Consumer Disputes Redressal Commission NCDRC
21-07-2020 Ex-Subedar Vinod Kumar Sharma Versus National Insurance Co. Ltd. National Consumer Disputes Redressal Commission NCDRC
21-07-2020 Maruti Suzuki India Limited, New Delhi Versus Mukesh Kumar & Others National Consumer Disputes Redressal Commission NCDRC
20-07-2020 Bajaj Allianz General Insurance Co. Ltd. & Another Versus Mahesh Gundappa Gouder In the High Court of Bombay at Goa
20-07-2020 National Insurance Co. Ltd. Through National Legal Vertical, New Delhi Versus M/s. Krishna Spico Industries Pvt. Ltd., Ghaziabad & Another National Consumer Disputes Redressal Commission NCDRC
17-07-2020 Branch Manager, Bajaj Allianz General Insurance Company Limited, Chhattisgarh Versus Ansat Siya & Others High Court of Chhattisgarh
17-07-2020 M/s. Arudra Engineering Private Limited, Represented by its Managing Director, R. Natraj Versus M/s. Pathanjali Ayurved Limited, Represented by its Director, New Delhi High Court of Judicature at Madras
16-07-2020 Bajaj Allianz General Insurance Co. Ltd. Versus Chandan Tulsidas Gauthankar & Others In the High Court of Bombay at Goa
10-07-2020 IFFCO Tokio General Insurance Co. Limited, Chhattisgarh Versus Kamin Bai & Others High Court of Chhattisgarh
10-07-2020 Bajaj Allianz General Insurance Co. Ltd. Versus Matilda Fernandes & Others In the High Court of Bombay at Goa
10-07-2020 Life Insurance Corporation of India Through Its Additional Secretary (Legal), New Delhi Versus Anil Laxman Matade National Consumer Disputes Redressal Commission NCDRC
09-07-2020 Khem Raj Verma & Others Versus Union of India, through Ministry of Human Resource & Development, Department of Higher Education, New Delhi & Another Central Administrative Tribunal Chandigarh Bench
09-07-2020 Abdul Wahid Bhat Versus Union of India, through Defence Secretary, New Delhi & Others Central Administrative Tribunal Chandigarh Bench
09-07-2020 Ravindra Versus Union of India, through its Under Secretary, General Administration Department, New Delhi & Others In the High Court of Bombay at Nagpur
09-07-2020 New Nagpur Mahila Gramin Vikas Credit Co-Operative Society Ltd. & Another Versus Suman Balaji Thakre National Consumer Disputes Redressal Commission NCDRC
08-07-2020 Velankani Information Systems Limited, Represented by its Manging Director, Kiron D. Shah Versus Secretary, Ministry of Home Affairs Government of India, New Delhi & Others High Court of Karnataka
07-07-2020 Rajesh Kumar Versus Union of India through the Secretary Ministry of Communication, New Delhi & Others Central Administrative Tribunal Principal Bench New Delhi
06-07-2020 National Insurance Co. Ltd., Chennai Versus A. Badurinssa & Others High Court of Judicature at Madras
06-07-2020 M/s. Liberty General Insurance Limited (formerly known as M/s. Liberty Videocon General Insurance Co. Ltd. Versus Md. Haseena & Others High Court of for the State of Telangana
03-07-2020 Bar Council of India, New Delhi, Represented by Its Secretary Versus Lokanath Behera Ips, Director, Vigilance & Anti Corruption Bureau, Thiruvananthapuram & Others High Court of Kerala
02-07-2020 Life Insurance Corporation of India, through Manager (L & HPF), (CG) Versus Dhanya Kumar Jain & Others High Court of Chhattisgarh
01-07-2020 Seema Shukla Versus New Delhi Municipal Corporation & Another High Court of Delhi
01-07-2020 M/s. Gulabchand Shankar Versus Oriental Insurance Co. Ltd., Rajasthan & Another National Consumer Disputes Redressal Commission NCDRC
30-06-2020 Dr. P.S. Sandeep & Others Versus The Government of India, Rep. by its Secretary to Government, Ministry of Health and Family Welfare, New Delhi & Others High Court of Judicature at Madras
30-06-2020 M/s. United India Insurance Company Limited Versus Md. Khayyumkhan & Others High Court of for the State of Telangana
30-06-2020 Union Bank of India, Through Shri R. Rajendra Prasad, Branch Manager, Raichur Versus M/s. Tirumala Enterprises, Raichur National Consumer Disputes Redressal Commission NCDRC
29-06-2020 R. Sampath Versus Union of India, Ministry of Home Affairs, rep. by its Secretary, New Delhi & Others High Court of for the State of Telangana
29-06-2020 Ramesh Malhotra & Another Versus Emaar Mgf Land Limited, Through its Managing Director, New Delhi & Another National Consumer Disputes Redressal Commission NCDRC
26-06-2020 Reliance Life Insurance Co. Ltd. & Another Versus Girijabai & Others National Consumer Disputes Redressal Commission NCDRC
26-06-2020 Sri Ananta Das, Assam & Others Versus Union of India, Represented by the Secretary to the Government of India, Ministry of Agriculture, New Delhi & Others High Court of Gauhati
26-06-2020 Reliance Nippon Life Insurance Co. Ltd. & Another Versus Sajal Kumar Banerjee National Consumer Disputes Redressal Commission NCDRC
25-06-2020 Amar Plastics Versus Iffco-Tokio General Insurance Co. Ltd. & Another National Consumer Disputes Redressal Commission NCDRC
25-06-2020 India Pentecostal Church of God, Represented by Its General President, Pastor (Dr.) T. Valson Abraham & Another Versus Government of India, Represented by Its Secretary, Ministry of Home Affairs, New Delhi & Others High Court of Kerala
25-06-2020 M/s. Goodwill Leather Art Rep By its Prop Md Quddus ALi Alias Md Quddus Ali Molla Versus National Insurance Co. Ltd. & Others National Consumer Disputes Redressal Commission NCDRC
25-06-2020 United India Insurance Co. Ltd. Versus Amar Singh Raghuwanshi National Consumer Disputes Redressal Commission NCDRC
23-06-2020 M/s. Acme Trade And Agencies, ASSAM Versus Union of India Rep. By The Secy. to the Govt. of India, Ministry of Finance, Deptt. of Revenue, New Delhi & Others High Court of Judicature at Madras
23-06-2020 Swetha Shri Selvakumar Versus Union of India, Rep. by its Secretary, Ministry of Human Resource Development, New Delhi & Others High Court of Judicature at Madras
23-06-2020 M/s. Jain Textiles, Ashok Jain Versus United India Insurance Company Ltd. National Consumer Disputes Redressal Commission NCDRC
22-06-2020 M/s. New Green Medical Hall Versus State of Bihar through the Principal Secretary, Health Department, Government of Bihar & Others High Court of Judicature at Patna
22-06-2020 M/s. New India Assurance Company Limited Versus Ravula Shanker @ Shanker Goud & Another High Court of for the State of Telangana
19-06-2020 Ram Avtar Versus National Insurance Co. Ltd. National Consumer Disputes Redressal Commission NCDRC
18-06-2020 Surendra Kumar Bhilawe Versus The New India Assurance Company Limited Supreme Court of India
18-06-2020 Rajendra Singh & Others Versus National Insurance Company Limited & Others Supreme Court of India
18-06-2020 Jaspreet Singh Bakshi Versus SBI General Insurance Company Ltd., Chandigarh & Others National Consumer Disputes Redressal Commission NCDRC
17-06-2020 Ashish Aggarwal Versus Pioneer Urban Land & Infrastructure Limited, New Delhi National Consumer Disputes Redressal Commission NCDRC
17-06-2020 D.D. Industries Ltd., New Delhi Versus Jasmeet Walia & Another National Consumer Disputes Redressal Commission NCDRC
16-06-2020 M/s. Sbi Cards & Payments Services Ltd., New Delhi Versus Vishal Sabharwal & Another National Consumer Disputes Redressal Commission NCDRC
16-06-2020 Savitha Versus M/s. Cholamandalam M.S. General Insurance Co. Ltd. & Others Supreme Court of India
16-06-2020 Union of India, Represented by The Secretary Posts, Ministry of Communication, Department of Posts, New Delhi & Others Versus G. Lakshmi & Others High Court of Kerala
15-06-2020 Piara Ram Versus National Insurance Co. Ltd. Through Its Manager, Punjab National Consumer Disputes Redressal Commission NCDRC
15-06-2020 Samri Devi Shaw Versus New India Assurance Co. Ltd., Mumbai & Others National Consumer Disputes Redressal Commission NCDRC
15-06-2020 The New India Assurance Company Limited, Thampanoor, Now Represented by Its Manager, Regional Office, Kochi Versus Managing Director, KSRTC, Thiruvananthapuram High Court of Kerala
15-06-2020 New India Assurance Company Ltd. Through Its Duly Constituted Attorney Manager, New Delhi Versus Aasha Devi & Another National Consumer Disputes Redressal Commission NCDRC
12-06-2020 Dr. D. Euvalingam & Others Versus The Secretary to Government, Ministry of Human Resource Development, New Delhi & Others High Court of Judicature at Madras
12-06-2020 M.H. Uma Maheshwari & Others Versus United India Insurance Co. Ltd. & Another Supreme Court of India
12-06-2020 M.V. Ramani Versus The Union of India, Rep. by its Secretary, Ministry of Health and Family Welfare, New Delhi & Others High Court of Judicature at Madras
12-06-2020 The New India Assurance Company Limited, Rep. by its Branch Manager, Punnam Chander complex, Chowrastha, Hanmkonda, Warangal Versus Sangeraboina Uppalaiah & Others High Court of for the State of Telangana
09-06-2020 Cry for Life Society, Thrissur, Represented by Its President, E.C. George & Others Versus Union of India, Represented by The Cabinet Secretary, New Delhi & Others High Court of Kerala
05-06-2020 Suresh Nair Versus Union of India, Represented by the Ministry of External Affairs, E-Block, Central Secretariat, New Delhi, Represented by its Secretary & Others High Court of Kerala
05-06-2020 Tanveer Jahan Versus All India Institute Of Medical Science, Through Its Director, New Delhi & Another National Consumer Disputes Redressal Commission NCDRC
05-06-2020 Vinita Sethi Versus ICICI Prudential Life Insurance Company Ltd. & Another National Consumer Disputes Redressal Commission NCDRC
04-06-2020 Goods & Services Tax Network, New Delhi & Others Versus M/s. Leo Distributors, Thrissur & Others High Court of Kerala
04-06-2020 M/s. United India Insurance Company Limited, Chennai Versus N. Prathap & Another High Court of Judicature at Madras
02-06-2020 Citizens Legal Right Association, Rep. by Its President, Joshy Kalluveettil & Another Versus Union of India, Through Its Secretary, Ministry of External Affairs, New Delhi & Others High Court of Kerala
02-06-2020 Indian Overseas Bank Officers' Association, Reg No: 321/MDS, Rep by its Joint General Secretary, R. Muthukumar Versus Union of India, Represented by its Secretary to Government, Ministry of Finance, New Delhi & Others High Court of Judicature at Madras
02-06-2020 New India Assurance Company, R.B.Road Extension, Mysore Versus Madevan & Another High Court of Judicature at Madras
01-06-2020 P. Subramanian Versus The Insurance Ombudsman, Teynampet & Others High Court of Judicature at Madras
27-05-2020 Union of India, Rep. by the Secretary, Department of Animal Husbandry, Dairying & Fisheries, Government of India, New Delhi & Another High Court of Judicature at Madras
27-05-2020 Jeetha Agnes Versus Union of India, Represented by The Secretary To Government of India, Ministry of Finance, Department of Revenue, New Delhi & Others High Court of Kerala
26-05-2020 Rajendra Kumar & Others Versus Raj Kumar High Court of Judicature at Allahabad
22-05-2020 Union of India, Ministry of Corporate Affairs, New Delhi Versus Oriental Bank of Commerce, Gurgaon National Company Law Appellate Tribunal
20-05-2020 A. Sennimalai Versus Tourism Finance Corporation of India Ltd., New Delhi & Others High Court of Judicature at Madras
20-05-2020 The Bank of New York Mellon, Through its attorney Navneet Singh Versus Indowind Energy Limited, Nungambakkam, Chennai High Court of Judicature at Madras
19-05-2020 K.N. Anilkumar Versus Bar Council of India, Represented by Its Secretary, New Delhi & Others High Court of Kerala
19-05-2020 Brij Kishore Dwivedi Versus Union of India, represented by and through the Secretary to the Government of India, New Delhi in the Ministry of Home Affairs, South Block, New Delhi & Others High Court of Tripura
19-05-2020 Branch Manager Tata AIG General Insurance Company Limited, Bilaspur C.G. Versus Kashi Ram Sahu & Others High Court of Chhattisgarh
18-05-2020 RM. Swamy Versus Government of India, Rep. by its Secretary, Ministry of Home Affairs, New Delhi & Others High Court of Judicature at Madras
15-05-2020 Jacob George Versus The Secretary Department of Information & Broadcasting, New Delhi & Others High Court of Karnataka
15-05-2020 T. Sivakumar Versus The Secretary to Government of India, Ministry of Petroleum and Natural Gas, A-Wing, New Delhi & Others High Court of Judicature at Madras
14-05-2020 Rajendra Kumar Chandrol Versus High Court of Madhya Pradesh
08-05-2020 Ibrahim Elettil, President, Dubai KMCC, Elettil, Kozhikode & Others Versus Union of India, Represented by Its Secretary, Ministry of External Affairs, New Delhi & Others High Court of Kerala
07-05-2020 Asa Uma Farooq Versus Union of India, through its its Secrtary, Ministry of Home Afairs, Government of India, New Delhi & Others High Court of Judicature at Madras
05-05-2020 K. Lakshmanan, Adilabad, Telangana Versus Union of India, Represented by Secretary, Department of Defence, New Delhi & Others High Court of Kerala