9911796707
TMI Blog2010 (9) TMI 214X X X X Extracts X X X X X X X X Extracts X X X X ..... be on the basis that the policy is ‘continued’ with effect from 30-7-2003. As held in subsequent Award dated 26-4-2005, Respondent No.1 ought to have collected the premium pro rata for the period 30-7-2003 to 14-4-2004 and renewed the mediclaim policy of the deceased Petitioner for this period as well. The communication dated 18-3-2004 from the office of the governing body of the General Insurance Council at Mumbai advising the Insurance Ombudsman not to entertain complaints in respect of non-renewal of mediclaim policies, was issued on the same date as the Award of the Insurance Ombudsman i.e. 18-3-2004. Without examining the question of validity of such advice, this Court is of the view that the said advice could not govern the Award dat ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... , and pay him the admissible claim amounts. 2. The facts leading to the filing of this petition are that on 30-7-1999 the Petitioner took a mediclaim policy from National Insurance Company Ltd. ('NICL'). This policy was regularly renewed till 29-7-2002. Thereafter, the Petitioner switched over to Respondent No.1. The policy was to expire on 28-7-2003 and on 10-7-2003 the Petitioner deposited a cheque of Rs. 10,129 with Respondent No.1 for renewal of his mediclaim policy. It may be mentioned that by that time, the Petitioner had lodged the following claims which were all paid by Respondent No.1: Sl. No. Treatment Period Amount Status (A) 20-1-2003 to 26-2-2006 41,283 Paid (B) 18-3-2003 to 10-4-2003 36,654 Paid (C) 18-4-2003 to ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... Ombudsman by pointing out that during the previous years the Petitioner had a policy with the NICL i.e. from 30-7-1999 till 29-7-2002. He had made no claim and in fact had earned a cumulative bonus of 15%. The second reason was that the Petitioner had concealed material facts in his proposal form that he was suffering from hypertension and bronchitis. This was also rejected by the Insurance Ombudsman. It was noticed that in a covering letter dated 8-2-2003, the complainant described his case history and that he had been hypertensive for the last four years. However, there was no concrete evidence to show that there was a firm diagnosis of hypertension prior to 30-7-1999. Further, there was no diagnosis of the Petitioner suffering from bron ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... he Petitioner's policy was renewed from 15-4-2004 to 14-4-2005. The Petitioner then wrote to Respondent No.1 on 24-4-2004 pointing out that this failure to renew the policy from 30-7-2003 onwards may have been because of an inadvertent error and that the necessary endorsement should be made on the renewed policy. He followed this by reminders on 28-4-2004 and 12-5-2004. When there was no response, he was compelled to again approach the Insurance Ombudsman with a letter dated 14-5-2004. 9. The stand of Respondent No.1 was that the Insurance Ombudsman had 'decided to treat the policy as continuous renewal without break without any exclusions (although there is gap in insurance) for all future claims except all claims incurred during the inte ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... ssions of Mr. Salil Paul, learned counsel for Respondent No. 1 have been heard. He submitted first that although Respondent No. 1 had not challenged the Award dated 18-3-2004 or subsequent directions dated 26-4-2005 of the Insurance Ombudsman, Respondent No.1 had in fact partly implemented the said Award by renewing the mediclaim policy from 15-4-2004 to 14-4-2005. When asked why the policy was not renewed with effect from 30-7-2003 itself, he referred to section 64VB of the Insurance Act which lays down 'no risk to be assumed unless premium is received in advance'. It is submitted that since Respondent No.1 had not collected the premium for the period 30-7-2003 to 14-4-2004, it could not entertain the claims arising during this period. Sec ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... nsurance companies have themselves devised this dispute redressal mechanism. They have also bound themselves unconditionally to honour such Award of such Insurance Ombudsman. It is too late in the day for Respondent No.1 to seek to wriggle out of the Awards dated 18-3-2004 and 26-4-2005 of the Insurance Ombudsman on any ground whatsoever. The decision in B. Krishna Bhat's case (supra) was in a different set of facts. In that case there was no order of the Insurance Ombudsman that was binding on the insurance company. 16. The Award dated 18-3-2004 has in fact been acted upon by Respondent No.1, but for some reason, only in part. The reasons for not renewing the policy continuously from 30-7-2003 as mandated by the Award dated 18-3-2004 are ..... X X X X Extracts X X X X X X X X Extracts X X X X
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