The High Court dismissed a writ petition challenging an Insurance Ombudsman's order directing an insurance company to pay Rs.10,39,000 as ex-gratia compensation. The court held there was no intentional concealment of pre-existing hypertension and found the Ombudsman's interim order prudent.
This page shows the compact analysis of this judgement. The full analysis — procedural history, issue-by-issue holdings with ratio and obiter, advocates, and paragraph-level evidence for every claim — is being added to the record in batches and will appear here when this judgement has been through it.
3-wp-7767-2016
IN THE HIGH COURT OF JUDICATURE AT BOMBAY CIVIL APPELLATE JURISDICTION
WRIT PETITION NO.7767 OF 2016
National Insurance Company Ltd. ..Petitioner V/s. Mr.Virendra Madhusudan Joshi ..Respondent
..Respondent
Mr.Asim Vidyarthi for the Petitioner.
Mr.Vijay S. Bhadkamkar, for the Respondent.
CORAM : C.V. BHADANG, J.
DATE : 21st FEBRUARY 2020
P.C.
grounds:-
(i) That there was suppression of material fact on the part of the respondent, in respect of the preexisting diseases. It is submitted that the respondent has failed to disclose in the data-sheet that he was
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suffering from Hypertension and was on medication for the said purpose. In the submissions of the learned counsel for the petitioner, the Insurance Policy itself is a proposal-cum-policy and respondent had clearly failed to answer a material question about pre-existing diseases.
(ii) It is submitted that the Ombudsman while granting the compensation by way of ex-gratia, payment could not have granted the bill amount of the risk covered under the policy. Inotherwords the Ombudsman can only grant a certain amount by way of token compensation/damages leaving it to the parties to take resort to an appropriate remedy and;
(iii) The Ombudsman has not recorded any reasons while granting the claim.
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there is no reason why the petitioner acted on the same. It is submitted that now the petitioner cannot turn around and disown the liability. Secondly, it is submitted that the Ombudsman has rightly found that the pre-existing ailment has nothing to do with the episode of acute IHD which the respondent suffered during his travel in Australia. In this regard the learned counsel has referred to the certificate dated 12th February 2015 given by Dr.Shrirish Hirimath from Pune. It is submitted that this being a finding of fact, this Court would be slow in interfering with such a finding, particularly which is of a technical nature.
made. Admittedly, in this case, there is no formal proposal form obtained from the respondent. The data sheet which is at page 25 of the compilation indeed shows that the question about pre-existing illness or medicine is neither answered in the affirmative nor in the negative. The said datasheet which is styled as a “confirmation of availability of insurance (part-II)” is singed both by the authorised signatory of the petitioner and the respondent. It does not appear that the question about pre-existing illness or medicine was answered either in the affirmative or in the negative so as to demonstrate that there was an active or intentional concealment on
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behalf of the petitioner. It is necessary to note that if at all a particular question which was material before the petitioner could have issued the medical policy was not answered either in the affirmative or in the negative, it was for the petitioner to have verified the same.
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The amount deposited before this Court along with
interest, if any, shall be paid to the respondent after a period of six
weeks.
C.V. BHADANG, J.
N.S. Kamble page 5 of 5
3 issues framed by the court
Whether there was suppression of material facts regarding pre-existing diseases by the respondent in the insurance proposal.
Whether the Insurance Ombudsman erred in granting full bill amount as ex-gratia payment without recording detailed reasons.
Whether the High Court in its supervisory jurisdiction should interfere with the Ombudsman's order.
National Insurance Company Ltd.
Mr. Virendra Madhusudan Joshi
C.V. Bhandari
As recorded by the court registry
Judgements on the same questions, provisions and authorities, from every court
