OM PRAKASH AHUJA versus RELIANCE GENERAL INSURANCE CO. LTD. ETC.

Citation: [2023] 10 S.C.R. 83 · Decided: 04-07-2023 · Supreme Court of India · Bench: ABHAY S. OKA · Disposal: Appeal(s) allowed

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Judgment (excerpt)

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[2023] 10 S.C.R. 83 : 2023 INSC 598
83
OM PRAKASH AHUJA
v.
RELIANCE GENERAL INSURANCE CO. LTD. ETC.
(Civil Appeal Nos. 2769-2770 of 2023)
JULY 04, 2023
[ABHAY S. OKA AND RAJESH BINDAL, JJ.]
Consumer Protection Act, 1986: Insurance claim –
Repudiation of – Denial of renewal of policy – On facts, pursuance
to the health insurance policy, the claimant incurred expenses on
the treatment of his wife for ovarian cancer – Claim for
reimbursement of expenses made to the respondent-Insurance
company, however, the same was repudiated on the ground of non-
disclosure by the claimant that his wife was suffering from a
rheumatic heart disease – Filing of complaint – Allowed by the
District Forum and issuance of direction for renewal of the health
insurance policy upon payment of premium – Upheld by the State
Commission – However, the National Commission though upheld
the directions as regards reimbursement of expenses incurred
however, set aside the direction for renewal of the health insurance
policy – Meanwhile, the claimant sought renewal of policy from
07.07.2009, but the same was denied by the respondent on the ground
of concealment of material facts – However, for the said period, policy
renewed in the year 2011 – Thereafter, for the period 2009 till 2011,
claimant sought reimbursement of expenses incurred for the wife’s
treatment, however, the same was not allowed – In revision petition,
the National Commission held that once the renewal of the policy
beyond 06.07.2009 was not proper, no claim was admissible – On
appeal, held: Even the Insurance Company accepted the fact that
non-mentioning of the disease from which the wife of the claimant
suffered at the time of purchasing the policy was not material, as the
death was caused from a different disease all together – Both had no
relation with each other – Insurance company cannot be permitted to
raise same plea to deny renewal of insurance policy to the claimant
for the period from 07.07.2009 onwards – Moreover, the amount
of premium charged by the insurance company for renewal of
policies has not been refunded – Meaning thereby the premium for
renewal of the policies for the said period stands paid – Once there
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84
SUPREME COURT REPORTS
[2023] 10 S.C.R.
is a valid insurance policy available in favour of the claimant, the
claim made by him for reimbursement of the expenses is justifiable
and is to be paid to him – Thus, the impugned order passed by the
National Commission set aside.
Allowing the appeals, the Court
HELD : 1. The ground on which renewal of insurance policy
to the appellant is sought to be refused is that while taking the
initial policy, the appellant had failed to disclose that his wife (now
deceased) was suffering from rheumatic heart disease. Though
she expired of cancer. The fact remains that the first policy was
taken by the appellant for the period from 07.07.2007 to
06.07.2008, which was renewed for another year. The claims even
for the period, wherein valid policy was available with the
appellant, were repudiated. Renewal of policy beyond 07.07.2009
onwards was refused relying upon the guidelines issued by the
Insurance Regulatory and Development Authority vide
communication dated March 31, 2009. The claim of the appellant
was repudiated on that very ground namely non–disclosure of
the disease by which the wife of the appellant (now deceased)
suffered at the time of purchase of initial policy. The repudiation
of claim by the insurance company was subject matter of
consideration before the Fora at different levels under the
Consumer Protection Act, 1986. The rejection of the claim on
the ground that there was concealment of certain material facts
by the appellant at the time of purchase of policy, was not found
to be tenable and the insurance company was directed to
reimburse the expenses incurred for the period from 07.07.2007
to 06.07.2009. The said amount was paid by the insurance
company. The order passed by the National Commission was not
challenged any further by the Insurance Company. From this, it
is established that even the Insurance Company accepted the
fact that non–mentioning of the disease from which the deceased
wife of the appellant suffered at the time of purchasing the policy
was not material, as the death was caused from a different disease
all together. Both had no relation with each other. Now, the
insurance company cannot be permitted to raise same plea to
deny renewal of insurance policy to the ap

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