Disposed

Sunil Ramdas Nemade v. Care Health Insurance Ltd.

Bombay HC3 Dec 2024WP/3118/2024

Case brief

AI extract

What is this about?

Writ petition against rejection of health insurance claims on grounds of non-disclosure of an autistic disorder and the Insurance Ombudsman's order upholding it. Parties settled by consent; the Court quashed the impugned order and letter and directed payment of Rs.23,04,223/- within 45 days, with compliance reporting.

What did the court decide?

Impugned Ombudsman order and insurer rejection letter quashed; insurer directed to pay Rs.23,04,223/- within 45 days towards two claims; no costs.

Sunil Ramdas Nemade vs Care Health Insurance Ltd. — Consumer Protection | Bombay HC (2024)

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903-WP-3118-2024.DOC

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IN THE HIGH COURT OF JUDICATURE AT BOMBAY ORDINARY ORIGINAL CIVIL JURISDICTION

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WRIT PETITION NO.3118 OF 2024

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Sunil Ramdas Nemade & Anr. …Petitioners Versus Care Health Insurance Ltd. & Ors. …Respondents

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Mr. Rajesh Sahani with Ms. Reshma Nair i/b. Mr. Devmani Shukla, Advocates, for the Petitioner.

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Mr. Rajesh Kanojia(through Video Conference), Advocate, i/b. Res Juris, for the Respondent Nos.1 and 2.

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CORAM: MADHAV J. JAMDAR, J. DATED : 19^th DECEMBER 2024

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P. C.:

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The challenge in this Writ Petition filed under Article 226 of

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the Constitution of India is to the legality and validity of the order dated 12^th January 2024 of the Respondent No.3-Insurance Ombudsman and to the letter/email dated 11^th August 2023 of the Respondent No.1-Care Health Insurance Limited by which the claim of the Petitioners has been rejected on the ground that the Petitioner No.2 is known case of Autistic Disorder and the same

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has not been disclosed during the inspection. However, it is the contention of the Petitioners that the said condition of the

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903-WP-3118-2024.DOC

Petitioner No.2 was disclosed and the Respondent No.1-Care Health Insurance Limited i.e. insurer is aware about the same.

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On earlier date, Mr. Rajesh Kanojia, learned Counsel appearing for the Respondent Nos.1 and 2 has taken instructions and submitted that the Respondent Nos.1 and 2 have decided to settle the dispute. There are two claims of the Petitioners of aggregate amount of Rs.30,42,082/-. The Respondent No.1 by settlement agreed to pay to the Petitioners aggregate amount of Rs.23,04,223/- (Rs.11,66,769/- + Rs.11,37,454/-).

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Mr. Rajesh Sahani, learned Counsel appearing for the Petitioners by communication dated 16^th December 2024 addressed to the learned Counsel appearing for the Respondent Nos.1 and 2 gave consent for accepting the said cumulative amount of Rs. 23,04,223/- instead of the claim of Rs.30,42,082/-.

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Mr. Kanojia, learned Counsel appearing for the Respondent Nos.1 and 2 states that by email dated 18^th December 2024, the Respondent No.1-Care Health Insurance Limited has approved the claim of said amount of Rs.23,04,223/-. Communication dated 16^th

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903-WP-3118-2024.DOC

December 2024 sent on behalf of the Petitioners and email dated 18^th December 2024 of the Respondent No.1 are taken on record and marked ‘X1’ and ‘X2’ for identification.

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Accordingly, the Writ Petition is disposed of by consent of the parties by passing the following order:

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ORDER

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(a) The impugned order dated 12^th January 2024 of the Respondent No.3-Insurance Ombudsman and letter/email dated 11^th August 2023 of the Respondent No.1-Care Health Insurance Limited are quashed and set aside.

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(b) By consent of the parties, it is directed that the Respondent No.1-Care Health Insurance Limited shall pay to the Petitioners aggregate amount of Rs.23,04,223/- within a period of 45 days from today towards two separate claims of the Petitioners.

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903-WP-3118-2024.DOC

(c) The Petitioners to immediately forward the documents as required by the Respondent No.1-Care Health Insurance Limited.

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The Writ Petition is disposed of in above terms with no order as to costs.

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This Court places on record appreciation of the Respondent No.1 -Care Health Insurance Limited for taking sympathetic view of the matter and Mr. Kanojia, learned Counsel appearing for the Respondent Nos.1 and 2 for facilitating the same.

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Although the Writ Petition is disposed of, stand over to 10^th February 2025 for reporting compliance of this order.

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[MADHAV J. JAMDAR, J.]

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Digitally signed by SONALI SONALI MILIND MILIND PATIL PATIL Date: 2024.12.20 12:44:35 +0530

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Sonali

Sunil Ramdas Nemade v. Care Health Insurance Ltd.

Case brief

What is this about?

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Sunil Ramdas Nemade v. Care Health Insurance Ltd.

Case brief

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