Writ petition filed by insurance company to quash Insurance Ombudsman award directing claim payment for death due to Dengue. Court held death not accidental as disease excluded per policy terms and award relied on overruled judgment.
Quashed impugned award dated 10.08.2018 and upheld repudiation of claim application by petitioner.
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.
WP No. 50472 of 2018
IN THE HIGH COURT OF KARNATAKA AT BENGALURU DATED THIS THE 16TH DAY OF MARCH, 2023
BEFORE
THE HON'BLE MR JUSTICE RAVI V HOSMANI WRIT PETITION NO. 50472 OF 2018 (GM-RES)
BETWEEN:
THE SBI GENERAL INSURANCE COMPANY LIMITED, 101, 201, 301 ACOCNATRAJU, JUNCTION OF WESTER EXPRESS HIGHWAY, ANDHERI KURLA ROAD, ANDHERI (EAST) MUMBAI-400 069. REP. BY AUTHORIZED REPRESENTATIVE MR AKASH JHA.
…PETITIONER
(BY SRI M.S. RAJENDRA, ADVOCATE FOR SRI VIVEK HOLLA, ADVOCATE)
AND:
Digitally signed by GURURAJ D Location: High Court of Karnataka
…RESPONDENTS
(NOTICE SERVED AND UNREPRESENTED TO R1 & R2)
THIS W.P. IS FILED PRAYING TO QUASH THE AWARD DATED 10.08.2018 VIDE ANNEXURE-L PASSED BY THE R-1 AND GRANT AN AD-INTERIM ORDER TO STAY THE AWARD DATED 10.08.2018 VIDE ANNEXURE-L PASSED BY THE R-1.
WP No. 50472 of 2018
THIS PETITION, COMING ON FOR PRELIMINARY HEARING B-GROUP, THIS DAY, THE COURT MADE THE FOLLOWING:
ORDER
Challenging impugned award bearing
no.IO/BNG/A/GI/0141/2018-19 dated 10.08.2018 (AnnexureL) passed by respondent no.1 - Ombudsman, this writ petition is filed.
WP No. 50472 of 2018
Against said rejection, respondent no.2 approached respondent no.1 - Ombudsman.
WP No. 50472 of 2018
(copy of which was produced along with memo today). In said conditions, definition of accident would mean “ a sudden, unforeseen and involuntary event caused by external, visible and violent means ”. It also pointed out that said conditions also contained General Exclusions clause, specifically excluding “ any pre-existing disability, disease or any complication arising from it ”, which would mean that risk due to ‘ disease ’ was generally excluded from coverage.
WP No. 50472 of 2018
unforeseen and involuntary event caused by external, visible and violent means. But as reason for death in instant case indicated in death summary report issued by Manipal Hospital at Annexure-D, clearly states that death was due to ‘Dengue’, a disease, it would not be due to accident covered under policy, in view of specific General Exclusions. Therefore, repudiation of claim by petitioner would be justified.
Sd/JUDGE
GRD
3 issues framed by the court
Whether repudiation of insurance claim for death due to disease with general exclusion applicable is justified despite Ombudsman award.
Whether impugned order of Insurance Ombudsman relying on later overruled decision is sustainable.
Whether death caused by Dengue fever falls within accidental death coverage of Group Personal Accident policy.
Colour shows how this judgement treated each authority
Branch Manager, National Insurance Company Ltd. v/s Mousumi Bhattacharjee and Ors., 2019 (5) SCC 391Distinguished¶29
The SBI General Insurance Company Limited
Insurance Ombudsman
Mr. Sankappa Sपालnga
ravivhosmani
As recorded by the court registry
Judgements on the same questions, provisions and authorities, from every court
