Allowed

P.R.S. Raja v. M/S. Tata Aig Life Insurance Company

Kerala HC22 Sept 2014WP(C)/9359/2012

Case brief

AI extract

What is this about?

Court allowed the writ petition and set aside the Insurance Ombudsman's order dismissing a complaint on limitation grounds. It held that limitation cannot be conclusively determined without considering rival contentions about the timing of repudiation and final reply to representations, and remanded the matter for proper adjudication within two months. Overall quality: thin.

What did the court decide?

Ext.P4 order passed by the Insurance Ombudsman is set aside; complaint disposed within two months after opportunity of being heard.

P.R.S. Raja Vs M/S. Tata Aig Life Insurance Company — Consumer Protection | Kerala HC (2014)

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IN THE HIGH COURT OF KERALA AT ERNAKULAM

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PRESENT:

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THE HONOURABLE MR. JUSTICE A.MUHAMED MUSTAQUE

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MONDAY, THE 22ND DAY OF SEPTEMBER 2014/31ST BHADRA, 1936

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WP(C).No. 9359 of 2012 (T)

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PETITIONER :

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------------------

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P.R.S. RAJA, AGED 27 YEARS,

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S/O.PUSHPARAJAN, PERMANENTLY RESIDING AT RAJ BHAVAN, T.C.5/144, PEROORKKADA P.O., KUDAPPANAKUNNU VILLAGE, THIRUVANANTHAPURAM-695005.

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BY ADVS.SRI.P.T.DINESH SRI.C.N.SAMEER

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RESPONDENTS :

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----------------------

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1. M/S. TATA AIG LIFE INSURANCE COMPANY 6TH FLOOR, PENINSULA CORPORATE PARK, G.K.MARG LOWER PAPREL, MUMBAI-400 013.

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2. THE MANAGING DIRECTOR, M/S.TATA AIG LIFE INSURANCE COMPANY LTD., NO.302, BUILDING NO.4, INFINITY I.T.PARK, FILM CITY ROAD, DINDOSHI, MALAD (EAST), MUMBAI-400 097.

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3. INSURANCE OMBUDSMAN, REPRESENTED BY THE SECRETARY OFFICE OF THE INSURANCE OMBUDSMAN, 2ND LOOR PULINAT BUILDING, OPPOSITE COCHIN SHIPYARD, M.G.ROAD ERNAKULAM, KOCHI-682 015.

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R1& R2 BY ADVS. SRI.K.J.SAJI ISAAC DR.ELIZABETH VARKEY

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THIS WRIT PETITION (CIVIL) HAVING BEEN FINALLY HEARD ON 22-09-2014, THE COURT ON THE SAME DAY DELIVERED THE FOLLOWING:

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WP(C).No. 9359 of 2012 (T)

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APPENDIX

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PETITIONER(S) EXHIBITS

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EXT.P1: TRUE COPY OF THE RELEVANT PART OF THE POLICY ISSUED BY THE 1ST RESPONDENT COMPANY.

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EXT.P2: TRUE COPY OF THE RELEVANT PART OF THE APPLICATION FORM SUBMITTED BY SUBHA TO THE 1ST RESPONDENT COMPANY.

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EXT.P2(A): TRUE COPY OF THE FIRST LIFE INSURANCE SCHEME RECEIPT ISSUED BY THE 1ST RESPONDENT.

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EXT.P3: TRUE COPY OF THE LAWYER NOTICE ISSUED BY THE PETITIONER TO THE 1ST AND 2ND RESPONDENT ON 27.7.2009.

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EXT.P4: TRUE COPY OF THE COVERING LETTER DATED 10.10.2011 ALONG WITH THE ORDER NO.IO/KCH/L1/073/2011-12 BY THE INSURANCE OMBUDSMAN, KOCHI.

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RESPONDENTS' EXHIBITS : NIL.

//TRUE COPY//

P.A. TO JUDGE

A. MUHAMED MUSTAQUE, J.

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.......................................................................... W.P.(C) No.9359 OF 2012

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......................................................................... Dated this the 22nd day of September, 2014

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JUDGMENT

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This writ petition is filed challenging Ext.P4 order passed by the Insurance Ombudsman. The petitioner has approached the Ombudsman on account of non-payment of insurance amount claimed by the petitioner from the Insurance company. This has been rejected citing limitation in terms of Rule 13 (3) of the Redressal of Public Grievances Rules, 1998. The above Rule is re-produced as follows:

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“No complaint to the Ombudsman shall lie unless(a) The complainant had before making a complaint to the Ombudsman made a written representation to the insurer named in the complaint and either insurer had rejected the complaint or the complainant had not received any reply within a period of one month after the insurer concerned received his representation or the complainant is not satisfied with the reply given to him by the insurer;

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(b) The complaint is made not later than one year after the insurer had rejected the representation or sent his final reply on the representation of the complainant.”

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The rule shows that complaint made after one year

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after reply given to the insured on his representation will not be maintainable. The petitioner has stated in the complaint

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that the Insurance company has refused payment and

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W.P.(C) No.9359 OF 2012 2

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thereafter he sent a legal notice dated 27-07-2009 and petitioner did not receive any reply on his legal notice. Aggrieved by this, he approached the Insurance Ombudsman. Admittedly, the complaint was filed only on 29-08-2011.

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The Insurance Ombudsman, it seems, based on the averments in the complaint that the Insurance company has repudiated the claim of the insurer, presumed that the repudiation must have before the lawyer notice, found that the claim is barred by limitation. As it clearly indicates from the rules that reply must be in writing. No doubt, respondent Insurance company if able to substantiate the claim has been repudiated in writing the period of limitation has to be reckoned from that date. However, without adverting to rival contentions, Insurance Ombudsman proceeded on the assumption that repudiation might have been preceded the legal notice and reckoned the limitation from the date of legal notice. Inspite of any legal notice, no reply is given, there cannot be any limitation. It is a matter to be decided after adverting to the rival contentions on both sides as to whether it is barred by limitation or not. This court is only interdicting the orders of the Ombudsman in dismissing the complaint at the

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W.P.(C) No.9359 OF 2012 3

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threshold, without the rival contentions being considered.

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Accordingly, Ext.P4 is set aside. It is submitted by the parties that after the dismissal of the order passed by the Ombudsman, the petitioner has approached the civil court for claiming compensation. It is open for the Ombudsman also to consider any issue relating to the jurisdiction in regard to the claim raised before the civil court. The Ombudsman shall dispose the complaint of the petitioner within a period of two months after affording an opportunity of being heard to the petitioner as well as the Respondent.

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The writ petition is disposed of as above.

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A. MUHAMED MUSTAQUE, JUDGE.

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//true copy//

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P.S. to Judge

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St/-

P.R.S. Raja v. M/S. Tata Aig Life Insurance Company

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P.R.S. Raja v. M/S. Tata Aig Life Insurance Company

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