NCDRC Dismisses Complaint Against Religare Health Insurance Over Repudiation Of Aviation Training Accident Claim

The National Consumer Disputes Redressal Commission (NCDRC), comprising AVM J. Rajendra, AVSM VSM (Retd.), Presiding Member, and Justice Anoop Kumar Mendiratta, Member, dismissed two complaints filed against Religare Health Insurance (now Care Health Insurance), holding that aviation training was expressly excluded under the policy and, therefore, no deficiency in service was made out against the insurer. Brief Facts of the CaseThe complainants, Joydeep Banerjee and his father Sanjoy Kumar Banerjee, had obtained a Student Explore Super insurance policy from Religare Health Insurance Company Ltd. ( O.P. No.1) with a coverage of USD 3,00,000, along with an additional Adventure Sports Accidental Death (ADD) cover for Joydeep's pilot training.The opposite parties included Religare Health Insurance Company Ltd. (OP-1) along with its Claim Department – Travel (OP-2), Falck Global Assistance (OP-4)—the insurer's assistance service provider—and Bharat Bhooshan Rodhe and Suraj Rodhe (OP-3), who acted as intermediaries. The flight school and related entities were arrayed only as pro forma parties. During flight training in Miami, Joydeep Banerjee met with an accident caused by adverse weather, sustaining multiple fractures and serious injuries. The complainants approached the intermediary to file a claim under the policy, but Religare repudiated it, citing the exclusion of aviation or pilot training. Aggrieved, the complainants filed a writ petition before the Calcutta High Court, later withdrew it, and subsequently filed Consumer Complaint before NCDRC.A second, connected complaint filed by Mr. Ponkumar, a trainee who sustained injuries in the same aircraft accident during pilot training — was also heard along with the lead case. Both complaints challenged Religare's repudiation of claims arising from the same incident. Arguments By the Opposite Party The insurer, Religare Health Insurance, submitted that the claims had been rightly repudiated, as the policy expressly excluded coverage for injuries arising from aviation training. Since the complainant sustained injuries during flight training, the insurer contended that the exclusion directly applied. It was further argued that the additional Adventure Sports cover taken by the complainant did not apply to professional pilot training, as it was limited to hazardous sports activities. The insurer further emphasized that the complainants were given a 15-day review period at the time of purchasing the policy, during which they could have returned it if they disagreed with any of its terms. Having chosen not to do so, they could not later claim to have misunderstood the conditions of coverage. The insurer also contended that there had been no misrepresentation on the insurer's part and that the policy had been issued after full disclosure. Observations By the CommissionThe Commission observed that aviation training was expressly excluded under the policy and, therefore, no deficiency in service could be attributed to the insurer. The Commission held that the exclusion in the policy strictly denied coverage for professional pilot training. The Commission relying on Oriental Insurance Company Ltd. v. Samayanallur Primary Agricultural Co-op Bank, AIR 2000 SC 10 held that, courts must interpret the terms of a contract solely based on the language of the policy. It held that an insurance policy must be read strictly according to its content and ensure the principle of strict construction of insurance contracts.It further observed that the complainants had not exercised the “Free Look Period” to cancel the policy if they were dissatisfied with any of its terms. Any misunderstanding regarding the policy conditions, the Commission noted, could have been addressed by returning the policy within that period. Having failed to do so, the complainants could not later claim to have misunderstood the terms of coverage. The Commission observed that no deficiency of service was established, noting that the policy expressly excluded aviation training and that the insurer had rightly repudiated the claims in accordance with the policy terms. It found that the policy document clearly mentioned the exclusion of aviation training and noted that the optional adventure sports cover could not override Clause 5.33. The Commission observed that the State and National Commissions are well within their power to hold the terms and conditions of any contract void in the event of deficiency of service, however it noted that there was no deficiency of service and dismissed both the complaints. Case Title : JOYDEEP BANERJEE vs RELIGARE HEALTH INSURANCE COMPANY LTD. Case No : CC 274/2020 & CC 428/2020 Click Here To Read/Download The Order

NCDRC Dismisses Complaint Against Religare Health Insurance Over Repudiation Of Aviation Training Accident Claim

Muhammed Razik

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NCDRC Dismisses Complaint Against Religare Health Insurance Over Repudiation Of Aviation Training Accident Claim

Muhammed Razik

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INR 1099+GST

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