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Manubhai Dharmasinhbhai Gajera3, it was argued that the renewal of an insurance policy would imply that the existing terms would bind the parties. Placing reliance on Biman Krishna Bose v. It was emphasized that the appellants had not applied and obtained a fresh policy but had rather renewed an existing policy - as they did earlier from time to time annually. Arundhati Katju that the State Forum and the NCDRC fell into error in holding that the appellants were aware and were deemed to have been aware of the terms of the policy. It is argued by the counsel for the appellants Ms. These conditions - the NCDRC held - were known to the appellants or were presumed to be known since they had claimed under that policy and that it was not open to them to claim ignorance of the terms under the fresh policy which had placed percentage and monetary cap on certain types of surgical procedures.Ħ. The NCDRC upheld the insurer's contention that the insurance policy renewed by the appellants on was a fresh contract entered into between the parties which reflected changes compared with the previous terms. In these circumstances, the appellants approached the NCDRC with a revision petition. Aggrieved, the insurer approached the State Consumer Redressal Commission which by its order upset the findings of the Consumer Forum, holding that the terms of the policy were known to the appellants who were bound by it. On the basis of these findings, the District Forum directed the insurer to pay the appellants,₹ 1,75,000/- as the balance amount and also awarded ₹ 5,000/- as compensation.
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The District Forum allowed the appellants' complaint holding firstly that an insurance contract evidences a commercial transaction, and is to be construed like any other agreement, on its own terms subject to fulfillment of the conditions of uberrima fides i.e., utmost good faith by the parties and secondly that the insurer was under a duty to intimate to be insured with respect to change in terms before the renewal of the policy. The insurer also argued that having been issued with the policy document which was accepted by the appellants, the latter could not then complain that they were any amounts over and above the terms agreed upon.ĥ. The policy for the relevant year indicated that in respect of procedures (such as angioplasty), 70% of the policy limit could be claimed subject to an overall limit of ₹ 2,00,000/- for any one surgery or procedure. The insurer's position before the District Forum was that the terms and conditions of Mediclaim policy changed periodically. Exhausted, the appellants filed a complaint before the District Consumer Disputes Redressal Forum (hereafter "the District Forum"), Kottayam for a direction that the insurer ought to pay them ₹ 2,07,705/- along with costs and interests on the compensation.Ĥ.
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Feeling aggrieved, the appellants represented to the insurer, repeatedly and unavailingly to the insurer to make good the balance amount. The insurer, however, accepted the claim and paid the partial amount by releasing ₹ 2,00,000/- to them.ģ. The appellants submitted a claim for ₹ 3,82,705.27/- to the insurer, as amounts due under the contract of insurance policy, towards the expenses incurred by them. The second appellant had to undergo angioplasty in June ( to ) at Chennai. The monetary coverage of the policy was ₹ 8,00,000/- (₹ 4,25,000/- for the first appellant and ₹ 3,75,000/- for the second appellant). This receipt indicated that the insurance policy period would be operative from to. The appellants paid the requisite amount by cheque (issued on ) and in this regard the receipt was received from the insurer on. The reminder also intimated the appellants that the premium was ₹17,705/- and had to be paid by. Before the date of expiry of the Mediclaim (on ), the insurer sent a reminder to the appellants to renew their policy, if they so wished, annually. The policy renewed by the appellants on was in force for a year i.e., till. The policy was annual and was renewed successively, each year by the appellants by paying the appropriate premium - the last renewal policy forming the subject matter of the present appeal. The undisputed facts are that the appellants contracted with the respondent (hereinafter referred to as "the insurer"), and secured a medical insurance policy (hereinafter referred to as "Mediclaim"), for the first time in 1982. The appellants challenge the order of the National Consumer Disputes Redressal Commission ("the NCDRC") 1 which upheld the concurrent rejection of their application seeking relief.Ģ.