National Insurance Co. Ltd. vs VISHWANATH BANSAL

THE present appeal, filed by the appellant, under Section 15 of the Consumer Protection Act, 1986 (hereinafter referred to as ''the Act''), is directed against order dated 27.3.2002, passed by District Forum-III Janakpuri, New Delhi in Complaint Case No. 1649/2000 - entitled Shri Vishwanath Bansal v. National Insurance Co. Ltd.

THE facts, relevant for the disposal of the above mentioned appeal, briefly stated, are that the respondent Shri Vishwanath Bansal had filed a complaint under Section 12 of the Act before the District Forum averring therein that the appellant had taken a Mediclaim Insurance Policy from the respondent jointly in his own name and in the name of his wife Smt. Laxmi Bansal. It is stated that the above said Mediclaim Policy, taken by the respondent and his wife jointly, was being renewed periodically after paying the requisite premium. It was stated that during the year 1996-97 the respondent developed renal problem and in the course of his treatment was admitted in Sir Ganga Ram Hospital, New Delhi and had to incur and hospitalization and other expenses. It was stated that the respondent filed a claim for Rs. 62,679.25 under the above policy on 18.2.1998. It was stated that on 10.1.2000 the respondent received a letter dated 7.1.2000 repudiating the claim of the respondent. THE case of the respondent in the complaint, filed by him, before the District Forum in nutshell was that the repudiation of his claim by the appellant was unjustified. It was prayed in the complaint, filed by the respondent, that a direction be issued to the appellant to pay medical expenses of Rs. 62,790.25 together with interest @ 18% per annum. THE respondent had also claimed a compensation of Rs. 1,00,000/- and litigation expenses, amounting to Rs. 10,000/-. The claim of the respondent in the District Forum was resisted by the appellant. In the reply/written version filed on behalf of the appellant a preliminary objection was taken to the effect that there was no deficiency in service on the part of the appellant and that the claim had been rejected as per the terms of the policy.

The learned District Forum vide impugned order has partly allowed the complaint filed by the respondent and has given direction to the appellant to examine the bills of the respondent and thereafter to take a decision as to whether the respondent is entitled to the entire amount claimed as per the terms of the policy. The learned District Forum has also directed that a decision be taken by the appellant within 60 days from the date of receipt of the copy of the order. It has also been directed that as per decision taken by the appellant the amount of mediclaim, payable to the respondent be paid with interest @ 10% per annum from 7.1.2000 till realization. The learned District Forum has also awarded cost of Rs. 1,000/- to the respondent.

FEELING aggrieved, the appellant has preferred the present appeal under Section 15 of the Act. We have heard the learned Counsel for the appellant at length on the question of admission of the present appeal and have also carefully gone through the documents/material on record. In terms of the provisions contained in Section 15 of the Act, a person, aggrieved by an order, made by the District Forum, can prefer an appeal against such order to the State Commission within a period of 30 days from the date of the order. However, proviso to Section 15 of the Act provides that the State Commission may entertain an appeal even after the expiry of the above said period of 30 days, if it is satisfied that there was ''sufficient cause'' for not filing the same within the above said period. The words ''sufficient cause'' occurring in proviso to Section 15 of the Act, are of utmost significance. As per settled law, culled out from various judicial decisions, the above expression ''sufficient cause'', though deserves to receive a liberal interpretation, yet, a just and equitable balance has to be maintained between the right secured by the respondent as a result of expiry of the prescribed period of limitation and the injustice of depriving the appellant of adjudication of his grievances on the merits of his appeal for causes beyond his reasonable control, which means the cause is bona fide and beyond the control of the appellant. Though, no hard and fast line can be drawn as to what affords ''sufficient cause'' in a given case, yet, again, as per settled law, any cause which prevents a person from approaching the Court within time is ''sufficient cause''. In doing so, it is the test of a reasonable man in normal circumstances which has to be applied.

ADMITTEDLY, the present appeal has not been filed by the appellant within the prescribed period of 30 days because the order being impugned in the present proceedings was passed by the learned District Forum on 27.3.2002 and the present appeal has been filed by the appellant on 17.7.2002. Therefore, the question requiring consideration at the very threshold is as to whether the appellant has shown ''sufficient cause'' for not filing the appeal, in time, within the meaning of proviso to Section 15 of the Act. The appellant, along with the appeal has also filed an application seeking condonation of delay in filing the present appeal. The reason for not filing the appeal in time has been stated in para 2 of the above said application which reads as under : "2. That the order dated 27.3.2002 was received by the appellant Company on 16.4.2002 by the Counsel for the appellant Company. The same was referred to the panel doctor Dr. A.K. Batra who gave his report dated 25.5.2002 to the concerned office whereby he opine that the claim did not fall within the purview of the policy as the Exclusion Clause 4.1 was attracted. The matter was sent to Delhi Regional Office which after examining the matter referred the same to the Counsel who found that on the certified copy, the earlier Counsel had put his stamp and the last para was also inadvertently underlying by someone. The Counsel thereafter advised the Company to obtain a fresh copy of the order which was received by the Counsel on - and thereafter the matter was gone through and the appeal was prepared."

On a perusal of the contents of the above para it is apparent that certified true copy of the order, being impugned in the present proceedings, was received by the appellant on 16.4.2002 and if the period of limitation for filing the appeal is to be computed as commencing from the date of communication of the order, as has been held by the Hon''ble Supreme Court in case Housing Board, Haryana v. Housing Board Colony Welfare Association & Ors., reported as III (1995) CPJ 28 (SC), the present appeal should have been filed by 15.5.2002. The same, as already stated, has been filed much beyond the prescribed period of limitation on 17.7.2002. The reason assigned for not filing the appeal in time is that the concerned department of the appellant had referred the case to the panel doctor (Dr. A.K. Batra) who gave his report on 25.5.2002. After 25.5.2002 no details have been given except a bald statement has been made. The present application has been filed on behalf of the appellant without even caring to fill up the blanks. Delay in filing the appeal cannot be condoned as a matter of generosity. Proof of ''sufficient cause'' is a condition precedent for the exercise of such discretion by the Appellate Authority. In our above views, we stand fortified by a decision of the Hon''ble National Commission in case Vice Chairman, Delhi Development Authority v. O.P. Gauba, reported as III (1995) CPJ 18 (NC)=1986-96 Consumer 2731 (NS).z

IN the presence of the above facts and the position explained above, in our opinion, whatever liberal interpretation might be put on the words ''sufficient cause'' it would be impossible for us to hold that there was no negligence on the part of the appellant. IN our opinion, as a matter of fact, in the given facts, the appellant has miserably failed to show ''sufficient cause'' for condoning the delay in filing the present appeal and, therefore, the present application seeking condonation of delay in filing the present appeal is hereby rejected.

THE present appeal, filed by the appellant, besides being barred by limitation is also devoid of substance on merits because the learned District Forum vide impugned order has simply given directions to the appellant to re-examine the claim of the respondent and thereafter to take a decision within 60 days from the date of receipt of the copy of that order and thereafter to pay the amount due and payable to the respondent under the policy together with interest @ 10% per annum w.e.f. 7.1.2000 till payment. In our opinion, no fault can be found with the above finding of the learned District Forum and in the given facts the same calls for no interference by this Commission in exercise of its appellate powers. Thus, viewed from all angles, the above mentioned appeal, filed by the appellant, is devoid of substance. THE same merits dismissal. Accordingly, the same is dismissed in limine with no order as to cost. Appeal dismissed in limine.