Content Provider | Supreme Court of India |
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e-ISSN | 30484839 |
Language | English |
Access Restriction | NDLI |
Subject Keyword | Consumer Protection Act Insurance policy |
Content Type | Text |
Resource Type | Law Judgement |
Jurisdiction | India |
Act(s) Referred | Consumer Protection Act, 1986 (68 of 1986) |
Case(s) Referred | Referred Case 0 Referred Case 1 Referred Case 2 Referred Case 3 Referred Case 4 Referred Case 5 Referred Case 6 Referred Case 7 Referred Case 8 Referred Case 9 Referred Case 10 Referred Case 11 Referred Case 12 |
Case Type | Appeal |
Court | Supreme Court of India |
Disposal Nature | Appeal Allowed |
Headnote | Consumer Protection Act, 1986 – s.2(g) – Insurance policy – Renewal of – Limitations imposed on Insurer’s liability – Non- disclosure by Insurer – Deficiency in service – Appellants had an annual medical insurance policy with the respondent-insurer – Policy was renewed successively by paying appropriate premium — Policy containing fresh terms was issued after receipt of the premium for the year 2008-09 – Introduction of the cap on the coverage by the insurer on certain types of surgical procedures – Second appellant underwent angioplasty in June 2008 – Appellants submitted claim to the insurer who accepted the claim but, paid the partial amount – District Forum allowed the appellants’ complaint – Findings upset by State Commission – Order upheld by NCDRC – On appeal, held: Per S. Ravindra Bhat, J. Appellants were kept in the dark and asked to renew a policy, the terms of which had undergone a significant change as its cover was radically different and imposed limitations on the insurer’s liability – Appellants were not informed that they had paid premium for a new policy, but were led to believe that they had in fact renewed a pre-existing policy on the same terms, with only difference being the removal of their son as a beneficiary and a higher coverage – Insurer was under a duty to inform the appellant about the limitations which it was imposing in the renewed policy — Failure to inform the policy holders resulted in deficiency of service – Per K.M. Joseph, J. (Supplementing) There was unjustifiable non- disclosure by the Insurer about the introduction of limitation clause which constituted a deficiency in service – Orders of NCDRC and State Commission set aside and that of the District Forum restored – Contract Act, 1872 – s.22 – Principle of uberrima fides – Constitution of India – Part IV – Arts.38, 39, 42, 47 – Insurance Regulatory and Development Authority, 1999 – Insurance Act, 1938 – IRDA (Health Insurance) Regulations, 2016 – Chapter III – Regulations 11, 13 -Universal Declaration of Human Rights 1948 – Article 25 – International Covenant on Economic, Social and Cultural Rights, 1976.Insurance – Renewed contract – Held: A renewed contract of insurance may provide terms which are different from the terms of the original contract of insurance – If the renewed contract is agreed in all respects by both parties, the fresh terms (with restrictions) would be binding.Insurance – Renewal of existing policy – Duty of insurers – Discussed.Consumer Protection Act, 1986 – s.2(g) – Deficiency in service – Held: In order to demonstrate deficiency, it is not necessary that the same emanates only from a law or a contract – The term “or otherwise” in s.2(g) clearly provides for circumstances where a certain level of service is expected from a provider.Doctrines/Principles – Insurance – Principle of uberrima fides – Applicability of – Discussed. Insurance – Standard Form Contracts – Unfair contractual terms – Refusal for enforcement of – Power of Courts – Discussed.Insurance – Role of insurance agents – Failure to discharge the duties – Vicarious liability of the insurer – DiscussedWords & Expressions – Contracts d’ adhesion – Held: Most policies- health and medical insurance policies being no exception, are in standard form – One who seeks coverage of a life policy/a personal risk, such as accident or health policy has little choice but to accept the offer of certain standard term contracts termed as contracts d’ adhesion, a French legal term. |
Judge | Hon'ble Mr. Justice K.M. Joseph Hon'ble Mr. Justice S. Ravindra Bhat |
Neutral Citation | 2021 INSC 853 |
Petitioner | Jacob Punnen & Anr. |
Respondent | United India Insurance Co. Ltd. |
SCR | [2021] 9 S.C.R. 787 |
Judgement Date | 2021-12-09 |
Case Number | 6778 |
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