National Consumer Disputes Redressal
National Insurance Co. Ltd. vs Manoj M. Lunked & Anr. on 30 March, 2015
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NEW DELHI REVISION PETITION NO. 1990 OF 2010 (Against the Order dated 18/02/2010 in Appeal No. 376/2007 of the State Commission Gujarat) 1. NATIONAL INSURANCE CO. LTD. Through The Manager, National Insurance Company Ltd., D.R.O.-I, Jeewan Bharti Building, Connaught Place New Delhi - 110001 Delhi ...........Petitioner(s) Versus 1. MANOJ M. LUNKED & ANR. AF-14, Rushika Apartment, Opp. Sujata Flats, Shahibaug Ahmedabad - 4 Gujarat 2. HERITAGE HEALTH SERVICES PVT. LTD. 63, City Centre, 6th Floor, Nr. Swastik Char Rasta, Navrangpura Ahmedabad - 9 Gujarat ...........Respondent(s)
BEFORE: HON'BLE MR. JUSTICE V.K. JAIN, PRESIDING MEMBER
For the Petitioner : Mr. Vijay Chandra Jha, Adv. for
Ms. Sonia Sharma, Advocate For the Respondent : NEMO
Dated : 30 Mar 2015 ORDER
JUSTICE V.K. JAIN, PRESIDING MEMBER (ORAL)
1. The complainant/respondent took a mediclaim policy from the petitioner for a sum of Rs.1,00,000/- for the period from 27-05-1995 to 26-05-1998, Rs.55,000/- for the period from 27-05-1998 to 26-05-1999, Rs.55,000/- from 27-05-1999 to 26-05-2000, Rs.2,00,000/- from 27-05-2000 to 26-05-2001, Rs.2,00,000/- from 27-05-2001 to 26-05-2002, Rs.2,00,000/- from 27-05-2002 to 26-05-3003 and Rs.2,00,000/- from 27-05-2003 to 26-05-2004.
2. It would, thus, be seen that the amount of the policy taken by the complainant was Rs.55,000/- during the period 27-05-1999 to 26-05-2000 which was increased by Rs.2,00,000/- with effect from 27-05-2000.
3. The complaint lodged a claim under the policy for the period 27-05-1999, 26-05-2000 in respect of his treatment for Hepatitis B and that payment, according to the learned counsel for the petitioner, was duly made to him. Thereafter, he lodged another claim for Hepatitis B, for a sum of Rs.2,60,000/- on the ground that he was hospitalized from 19-10-2003 to 20-10-2003 and 22-12-2003 to 23-12-2003 for diagnosis of Hepatitis B infection. The insurance company made a payment of Rs.57,250/- to him followed by another payment of Rs.6,000/-. However, the complainant was not satisfied with the aforesaid payment and approached the concerned District Forum seeking payment of the balance amount of Rs.1,96,750/- with interest. He also sought compensation and cost of litigation amounting to Rs.5,000/- each.
4. The complaint was resisted by the insurance company primarily on two grounds. The first ground taken was that Hepatitis B having been contracted for the first time when the insurance cover was only for Rs.55,000/-, his claim under the subsequent policy also will be restricted to Rs.55,000/- with proportionate no claim bonus. The second ground taken by the insurance company was that the complainant having accepted Rs.57,250/- in full and final settlement of his claim no further amount could be claimed by him.
5. Vide order dated 28-09-2006 the concerned District Forum directed the petitioner company to pay a sum of Rs.1,96,750/- to the complainant along with interest at the rate of 6% per annum. The petitioner company was also directed to pay Rs.2,000/- as compensation and Rs.2,000/- as cost of litigation to the complainant. Being aggrieved from the order of the District Forum the insurance company approached the concerned State Commission by way of an appeal. The said appeal having been dismissed vide order dated 18-02-2010 the petitioner company is before this Commission by way of this revision petition.
6. I find no merit in the first contention of the learned counsel for the petitioner company that since Hepatitis B was contracted by the complainant for the first time during currency of the policy for the period from 27-05-1999 to 26-05-2000, when the insurance cover was for Rs.55,000/-, the liability under the subsequent policy would also be restricted to that much amount and no claim bonus. Once the insurance company had increased the cover to Rs.2,00,000/-, the claim of the complainant was to be considered as per the enhanced insured amount and not on the basis of the insured amount of the previous policy.
7. However, I find merit in the contention that having accepted a sum of Rs.57,250/- in full and final settlement of his claim, the complainant was not entitled to any further payment from the insurance company as a matter of right. A perusal of the discharge voucher dated 16-02-2004 duly signed by the complainant would show that a sum of Rs.57,250/- was accepted by him in full and final settlement of his claim. Having accepted the aforesaid amount in full and final settlement of his claim the complainant was precluded from claiming a higher amount from the insurance company in respect of the claim which was subject matter of the said final settlement. Though the insurance company made a further payment of Rs.6,000/- to the complainant, considering the no claim bonus, that by itself would not entitle the complainant to claim a higher amount, despite having accepted the amount of Rs.57,250/- in full and final settlement of his claim.
8. This was not the case of the complainant anywhere in the complaint filed by him that the consent given by him while accepting the sum of Rs.57,250/- in full and final settlement of his claim was vitiated on account of the factors such as coercion, undue influence, fraud, mis-representation, etc.. Therefore, it was obviously a free consent which resulted in a binding contract between the parties, whereby the claim came to be satisfied on the complainant accepting the aforesaid amount.
9. For the reasons stated hereinabove, the impugned order is set aside and the complaint is accordingly dismissed. No order as to costs.
......................J V.K. JAIN PRESIDING MEMBER