Dismissed

Anil D v. the Oriental Insurance Co. Ltd.

Kerala HC14 Mar 2018WA/2683/2017

Case brief

AI extract

What is this about?

The appellant challenged the dismissal of a writ petition seeking a declaration that medical treatment was covered under an insurance policy. The Court held that coverage under the policy terms for the relevant year is a pure question of fact, which is impermissible for adjudication under Article 226. The appeal was dismissed.

What did the court decide?

The appeal was dismissed. The appellant was directed to approach the appropriate forum for the remedy.

Anil D Vs the Oriental Insurance Co. Ltd. — Insurance | Kerala HC (2018)

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IN THE HIGH COURT OF KERALA AT ERNAKULAM

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PRESENT:

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THE HONOURABLE THE CHIEF JUSTICE MR.ANTONY DOMINIC & THE HONOURABLE MR. JUSTICE DAMA SESHADRI NAIDU

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WEDNESDAY, THE 14TH DAY OF MARCH 2018 / 23RD PHALGUNA, 1939

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APPELLANT(S)/PETITIONER

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ANIL D S/O. DIVAKARAN AGED 35 YEARS ALAMUTTAM, 35/1158B CHAKKUNGAL ROAD PALARIVATTOR-682025

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BY ADVS.SRI.SOJAN MICHEAL SMT.JENCY MICHEAL

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RESPONDENT(S)/RESPONDENTS:

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THE ORIENTAL INSURANCE CO. LTD. ORIENTAL HOUSE P.B NO.7037/,A-25/27 ASAF ALI ROAD NEW DELHI-110 002 REPRESENTED BY ITS GENERAL MANAGER

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REGIONAL MANAGER THE ORIENTAL INSURANE CO. LTD REGIONAL OFFICE METRO PALACE OPP. NORTH RAILWAY STATION

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ERNAKULAM- 682018

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SENIOR BRANCH MANAGER THE ORIENTAL INSURANCE CO.LTD.

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BRANCH OFFICE, GOVERNMENT HIGH SCHOOL JUNCTION EDAPALLY, ERNAKULAM - 682224

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WA.No. 2683 of 2017

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-2-

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INSURANCE REGULATORY & DEVELOPMENT AUTHORITY OF INDIA (IRDA) CONSUMER AFFAIRS DEPARTMENT 9TH FLOOR UNITED TOWERS BASHEER BAGH HYDRABAD- 500 029

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UNION OF INDIA SECRETARY TO THE DEPARTMENT OF FINANCIAL SERVICES OF GOVERNMENT OF INDIA MINISTRY OF FINANCE (BANKING & INSURANCE), NEW DELHI-110001

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R1-R3 BY ADV. SMT.K.S.SANTHI R1-R3 BY ADV. SMT.LATHA SUSAN CHERIAN BY SRI.K.A.BALAN BY SRI.K.L.NARASIMHAN, SC TAC/IR & DA

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THIS WRIT APPEAL HAVING BEEN FINALLY HEARD ON 14-03-2018, THE COURT ON THE SAME DAY DELIVERED THE FOLLOWING:

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ANTONY DOMINIC, C.J. &

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DAMA SESHADRI NAIDU, J.

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W. A. No.2683 of 2017

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Dated this the 14^th day of March, 2018

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JUDGMENT

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Antony Dominic, C.J.

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The appellant approached this Court seeking a declaration that the treatment undergone by his father is covered by the medi claim policy. The writ petition having been dismissed, this appeal is filed.

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We heard the learned counsel for the appellant and the learned Senior Counsel appearing for the respondents.

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On hearing the rival parties, we find that this is the case of the appellant that even for the year 2016-17, the year in relation to which the claim arose, the terms and conditions of the policy were as contained in Ext.P1 policy issued for the year 2011. According to the learned counsel, under this policy, the treatment for Age Related Macular Degeneration (ARMD) was also covered.

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W. A. No.2683 of 2017

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-2-

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On the other hand, it is the specific case of the Insurance Company that from 2015-16 onwards, the terms of the policy have been revised and the policy issued to the appellant during 2015-16 contained the revised terms and conditions. It is stated that in terms of the revised conditions, the treatment for ARMD is specifically excluded. It is, therefore, that they argued that they were justified in repudiating the claim.

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Though this contention is sought to be contradicted by the learned counsel for the appellant by telling us that in the policy issued for the previous year itself, they were given an opportunity to opt for renewal for the existing document, viz. policy without any change in the terms and conditions, and that they had exercised such option. It is argued that it was on that basis, the policy was issued in 2016-17. According to the learned counsel, the appellant, therefore, is entitled to the benefit of coverage as claimed.

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According to us, the rival contentions raised before

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W. A. No.2683 of 2017

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us, as to whether the claim made by the appellant is covered by the terms of the policy issued for the year 201617 or not, is a pure question of fact, the adjudication of which is impermissible and impossible in a proceedings under Article 226 of the Constitution of India. We, therefore, hold that the writ petition was not the proper remedy for the appellant and the dismissal of the writ petition, is perfectly justified.

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The appeal, therefore, fails and is dismissed without prejudice to the contention raised by the appellant and the remedy open to him before the appropriate forum.

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Sd/-

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ANTONY DOMINIC CHIEF JUSTICE

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Sd/-

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DAMA SESHADRI NAIDU JUDGE

kns/-

//TRUE COPY//

P.S. TO JUDGE

W. A. No.2683 of 2017 -4-

Anil D v. the Oriental Insurance Co. Ltd.

Case brief

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Anil D v. the Oriental Insurance Co. Ltd.

Case brief

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