NCDRC Dismisses Complaints Against Religare Health Insurance; Holds Aviation Training Expressly Excluded From Policy Coverage
Pranav B Prem
The National Consumer Disputes Redressal Commission (NCDRC), comprising AVM J. Rajendra, AVSM VSM (Retd.) (Presiding Member) and Justice Anoop Kumar Mendiratta (Member), dismissed two consumer complaints filed against Religare Health Insurance Company Ltd. (now Care Health Insurance Ltd.), holding that aviation training was expressly excluded under the policy terms. The Commission ruled that there was no deficiency in service on the part of the insurer in repudiating claims related to injuries sustained during pilot training.
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The lead complaint (CC No. 274 of 2020) was filed by Joydeep Banerjee and his father Sanjoy Kumar Banerjee, who had obtained a Student Explore Super insurance policy from Religare Health Insurance for a sum insured of USD 3,00,000, along with an Adventure Sports Accidental Death (ADD) cover. The policy was taken to safeguard Joydeep against medical contingencies while pursuing a Professional Pilot Training Course at Dean International Inc. Flight School, Miami, USA. During the training, on May 4, 2018, Joydeep met with a serious aircraft accident due to adverse weather, suffering multiple fractures and injuries. He underwent several surgeries at Kendall Regional Medical Centre, Miami, and was later repatriated to India for further treatment. When his father submitted a claim for medical expenses, the insurer repudiated the claim citing Clause 5.33 of the General Exclusions, which specifically excluded any claim “relating to aviation training.” A connected complaint (CC No. 428 of 2020) was also filed by Ponkumar, another trainee injured in the same incident. Both complaints were heard together.
Complainants’ Contentions
The complainants argued that the policy had been purchased specifically for covering risks arising during pilot training, a fact disclosed to the insurer through its authorized intermediary Bharat Bhooshan Rodhe. They alleged that the intermediary assured them that the Adventure Sports Add-On would cover injuries sustained while piloting non-commercial aircrafts, and that the insurer had full knowledge of the purpose for which the policy was issued.
It was further submitted that the insurer’s reliance on the exclusion clause was contradictory and unjust, as the policy itself was marketed as suitable for “pilot training.” The complainants also invoked the Supreme Court’s ruling in M/s Texco Marketing Pvt. Ltd. v. Tata AIG General Insurance Co. Ltd. (2023) 1 SCC 428, arguing that any inconsistency between the policy certificate and general exclusions would render the exclusion clause void. They contended that the insurer’s refusal amounted to deficiency in service and unfair trade practice, as the company knowingly issued a policy meant to cover aviation-related risks but later denied liability using an exclusion clause.
Insurer’s Stand
The insurer, represented by Care Health Insurance Ltd., maintained that the repudiation was fully justified under Clause 5.33 of the policy, which excluded aviation training from coverage. It was emphasized that the Adventure Sports Add-On extended only to hazardous sports activities such as bungee jumping or paragliding and did not include professional pilot training.
The insurer further argued that the complainants had been granted a 15-day “Free Look Period” under Clause 8.10 of the policy to review and, if dissatisfied, cancel the policy. Having failed to exercise this option, they could not subsequently claim ignorance or misunderstanding of the exclusion clause. It was also contended that there was no misrepresentation on the insurer’s part and that the policy was issued after full disclosure of the terms and conditions.
Commission’s Observations
The NCDRC noted that it was undisputed that the complainants were undergoing pilot training and that the policy explicitly excluded aviation training under Clause 5.33 of the General Exclusions. The Commission emphasized that courts and consumer fora must interpret the terms of an insurance contract strictly as per the language used and cannot rewrite or modify its scope. Citing the Supreme Court’s ruling in Oriental Insurance Co. Ltd. v. Samayanallur Primary Agricultural Co-op Bank (AIR 2000 SC 10), the Commission observed that insurance policies must be construed strictly based on their express terms, and no artificial or extended meaning can be imported. The Bench observed: “The educational course details reflecting ‘professional pilot training’ in the policy cannot be read in isolation to override other terms and conditions. Clause 5.33 clearly excludes aviation training. The complainants had full liberty under Clause 8.10 to return the policy within the Free Look Period if they disagreed with its terms, but they chose not to do so.”
The Commission rejected the argument invoking the “blue pencil doctrine”, noting that it applies only when a contractual clause is unfair or illegal and capable of being severed without affecting the main contract. In this case, the exclusion clause was neither unfair nor inconsistent with the nature of the contract, as the insurer had not concealed any material fact. It further held that while the Consumer Protection Act empowers forums to declare unfair terms null and void, the complainants failed to establish any deficiency of service or unfair trade practice. The policy’s terms were clear, and there was no evidence that the insurer misled the insured.
The NCDRC concluded that the repudiation of the claim was valid, as aviation training was a clearly excluded risk. It held that the insurer had acted strictly in accordance with the policy and had provided adequate opportunity for the insured to review the terms during the free look period. “The optional cover for adventure sports under Clause 3.3 supersedes Clauses 5.31 and 5.32 but does not override Clause 5.33, which relates to aviation training. There is, therefore, no deficiency in service by the insurer.”
Accordingly, both Consumer Complaint No. 274 of 2020 (Joydeep Banerjee & Anr. v. Religare Health Insurance Co. Ltd.) and Consumer Complaint No. 428 of 2020 (Ponkumar & Anr. v. Religare Health Insurance Co. Ltd.) were dismissed, with no order as to costs. In essence, the Commission reaffirmed that aviation training is a specific exclusion under health insurance policies, and policyholders must exercise due diligence during the free look period to understand such exclusions before seeking coverage.
Cause Title: Joydeep Banerjee Vs Religare Health Insurance Company Ltd.
Case No: CC 274/2020 & CC 428/2020
Coram: AVM J. Rajendra, AVSM VSM (Retd.) (Presiding Member), Justice Anoop Kumar Mendiratta (Member)
