UNITED INDIA INSURANCE CO. LTD. vs Satish Aggarwal

THE petitioner was the opposite party before the District Forum, where the respondent/complainant had filed a complaint alleging deficiency in service on the part of the petitioner.

UNDISPUTED facts of the case are that the respondent/complainant had obtained a Hospitalisation and Domiciliary Hospitalisation Benefit Policy valid for one year for the period from 4.8.1994 to 3.8.1995, which as per policy issued by the petitioner, clearly stated that the policy was a renewal of the policy taken earlier for the period 3.8.1993 to 2.8.1994. During the life of the policy, valid from 4.8.1994 to 3.8.1995, the respondent/complainant suffered from enlargement of the prostrate and was advised surgery for removal of the enlargement for which he was hospitalized and the surgery was carried out.When the respondent/complainant submitted a claim of Rs. 38,385 on 6.6.1995, it was repudiated on the ground that it was not admissible under exclusion Clause 2.1.13, which reads as follows: "Exclusion for 1st year of policy or treatment of cataract, benign, prostatic hypertrophy, hysterectomy for menorrhagia or fibromyoma, hernia, hydrocele, congenital internal disease, fistula in anus, piles, sinusitis and relates disorders unless such diseases are excluded as pre -existing."

IT is in these circumstances, a complaint was filed before the District Forum, which allowed the complaint and directed the petitioner to reimburse the claimed amount with interest @ 12% p.a. within 30 days along with cost of Rs. 2,000. Aggrieved by this order, the petitioner filed an appeal before the State Commission, which was dismissed. Hence, this revision petition before us.

NONE appeared on behalf of the respondent. Since the notice sent to the respondent/complainant has not come back unserved, respondent/complainant, is presumed to have been served with the notice, hence we go on to pass the order after hearing the learned Counsel for the petitioner.

ADMITTEDLY , the respondent/ complainant has since died and his son, Mr. Vineet Aggarwal is the sole claimant as per our orders dated 19.10.2005 and 12.9.2006.

AFTER hearing the learned Counsel for the petitioner as also as discussed by both the lower Fora, the controversy is limited. It is the case of the petitioner, that the first policy issued by the petitioner in favour of Mr. Satish Aggarwal, original complainant, since deceased, was for the period from 3.8.1993 to 2.8.1994 and since new Policy was issued for the period from 4.8.1994 to 3.8.1995, there was a break of two days, on account of which the exclusion clause relating to, counting of first year in terms of exclusion clause reproduced earlier, will start from 4.8.94 and not relatable to the earlier policy, since there was a breach of two days between the expiry of old Policy and taking of new policy.

BOTH the lower Fora have discussed this point at length inferred against the petitioner.

AFTER hearing the learned Counsel for the petitioner and the perusal of material on record, we see that under the column in relation to the sub -condition in the original medi -claim policy issued on 4.8.1994 at 4.00 p.m. the wording used is "..renewal of Policy number..." What we need to examine is as to what are the effect of the word renewal''.

PRIMA facie ,we are unable to accept the argument advanced by the learned Counsel for the petitioner with regard to his contention that the new Policy should be deemed to be commencing from 4.8.1994. In our view, the plea loses its significance once the word renewal of policy'' is used in the policy issued on 4.8.1994. In our view the word renewal'' would mean continuation from the old policy. Had it been the intention of the petitioner that there is a break in the policy then perhaps the word renewal'' was not the right word to use.

WE have very carefully gone through the meaning of word renewal'' as it appears in Stroud''s Judicial Dictionary, Fifth Edition'', we would like to reproduce it: "(10) An agreement to grant a renewed'' lease or term, simplicitor, means the renewing, as from the expiry of the original term, of such term for a like period and (with one exception) on the like terms (per Lyndhurst C.B., Price v. Asheton, 4 L.J. Ex. Eq. 3, adopted by Bruce J. Lewis v. Stephenson, 67, L.J.Q.B. 296). The exception as to terms is that such renewed instrument will not, without clearly expressed words, include the agreement for renewal, the insertion of which would connote a perpetual renewal (per Bruce J., Lewis v. Stephenson, citing Iggulden v. May, 7 Ea. 237; Hyde v. Skinner, 2 P. Wms. 196; Baynham v. Guy''s Hospital, 3 Ves. 294. For an example of such clear words, see Hare v. Burges, 27 L.J. Ch. 86; to the contrary. Swinburne v. Milburn, 9 App. Cas. 844. See further As Often As; forever; from time -to -time). Therefore, an agreement for a term of 3 years, with the option of renewal,'' gives the tenant the right to call for a further agreement for three years and one the like terms (except the clause for renewal) as those contained in the first agreement; but he must exercise that option within a reasonable time before the expiration of the original term (Lewis v. Stephenson (supra). See Austin v. Newham, (1906) 2 K.B. 167, cited Option; Mostyn v. Fitzsimmons, (1903) 1 K.B. 354, cited costs of lease. See further; same. (Emphasis supplied)"

IN view of this meaning of word renewal'', and without any express words to the contrary, we have no hesitation in accepting the finding returned by both the lower Fora that the terms were the same as well as it will come into effect from the expiry of the original term, as has been explained in the Stroud''s Judicial Dictionary (in Sub -clause 10 above).

IN view of above, we are constrained to observe, that as rightly held by both the lower Fora, and in view of the meaning of the word given in the Stroud''s Judicial Dictionary, the period for insurance would be deemed to have commenced from 3.8.1993, as first year, and as a consequence exclusion clause shall be applicable from 3.8.1993 and not from 4.8.1993 as argued by the learned Counsel for the petitioner.

IN the aforementioned circumstances, we see no merit in this revision petition Dismissed. R.P. dismissed.