2001 (8) TMI 1233 - SC - Companies Law

Whether the appellant s policy was required to be renewed with effect from the date when it fell due for renewal? Whether the appellant can be directed to take a fresh mediclaim policy on the premise that no renewal of the policy can be ordered for the expired period? Held that - Appeal allowed. High Court committed an error in directing the appellant to take fresh mediclaim policy even after setting aside the order of refusal to renew the mediclaim policy by the insurance company. The order passed by the High Court to that extent is not sustainable in law. Thus set aside the order of the High Court to the extent it directed the appellant to take a fresh mediclaim policy & further direct that if the appellant applies for renewal of his mediclaim policy for the expired period and pays the premium, the respondent-company shall renew the said mediclaim policy forthwith.

Issues:
1. Refusal to honor mediclaim insurance claim.
2. Dispute over renewal of mediclaim policy.
3. Exclusion clause regarding pre-existing diseases.
4. Interpretation of renewal of insurance policy.
5. Arbitrariness in refusal to renew policy.
6. Requirement of fairness and reasonableness in insurance company actions.

Analysis:

1. The appellant and his wife took out a mediclaim insurance policy, but the insurance company failed to honor the claim for treatment expenses incurred by the wife. After a series of legal proceedings, the appellant approached the court for renewal of the policy, which was declined by the insurance company citing past litigation as a reason. The appellant challenged this refusal in court.

2. The High Court set aside the refusal to renew the policy but directed the appellant to take a fresh mediclaim policy instead of renewing the existing one. The appellant argued that this would disadvantage him due to pre-existing diseases not being covered under a new policy. The exclusion clause in the policy was crucial in this argument.

3. The General Insurance Business (Nationalisation) Act established acquiring companies with exclusive privileges to conduct general insurance business in India. The insurance company's refusal to renew the policy based on the appellant's past conduct of seeking legal redressal was deemed arbitrary and unfair by the court, considering the company's monopoly status and obligations under the Act.

4. The court emphasized that a renewal of an insurance policy should replicate the original policy's terms and conditions, and refusal to renew based on extraneous considerations could lead to the insured being deprived of coverage for diseases contracted during the non-renewal period. The court held that the policy should be renewed from the due date, despite the insurance company's argument regarding non-payment of subsequent premiums.

5. The judgment highlighted the need for fairness and reasonableness in insurance company actions, especially when dealing with renewal of policies. The court set aside the High Court's direction for the appellant to take a fresh policy and ordered the insurance company to renew the mediclaim policy for the expired period upon the appellant's application and payment of premiums.

6. The appeal was allowed, and costs were imposed on the insurance company. The court's decision aimed to remedy the harm caused to the insured due to the arbitrary refusal to renew the policy, ensuring the insured's right to coverage for medical expenses incurred during the relevant period.

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