The High Court dismissed a writ petition where the petitioner claimed balance medical reimbursement. The court held that since the lesser amount under the policy terms (Rs.25,000) was paid, the petitioner is not eligible for the claimed balance expenses. The petition was allowed to be disposed of without any other order.
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.
IN THE HIGH COURT OF JUDICATURE AT MADRAS
Dated : 14.06.2019
CORAM:
THE HON'BLE MR. JUSTICE P.D.AUDIKESAVALU
W.P. No.2931 of 2019
and
W.P.Nos.3196 and 3198 of 2019
-vs-
Chennai 600 034.
For the State of Tamil Nadu and Puducherry,
Office of the Insurance Ombudsman,
Fathima Akhtar Court, 4th Floor,
453, Anna Salai, Teynampet,
Chennai 600 018.
No.4 (Old No.44), Audiappa Street,
(Near Lauders Gate), Poo. Lady M.Ct. M. School, Purasawalkam, Chennai 600 084.
Chennai 600 035. ... Respondents
Prayer :- Writ Petition filed under Article 226 of Constitution of India, seeking for a Writ of Certiorarified Mandamus, to call for the records relating to the impugned letter Ref.No.010200/001-2018 dated 02.03.2018 issued by the first respondent herein namely the Senior Divisional Manager, M/s. The United India Insurance Company Limited, No.6, Ganga Griha, Nungambakkam High Road, Chennai 600 034, and the award bearing No. 10/CHN/A/G1/0284/2018-2019 dated 21.01.2019 passed by the 2nd respondent herein namely the Insurance Ombudsman, for the
State of Tamil Nadu and Puducherry, Office of the Insurance Ombudsman, Fathima Akhtar Court, 4th Floor, 453, Anna Salai, Teynampet, Chennai 600 018, quash the above two orders as nonest in the eye of law and consequently direct the 1st respondent herein namely the Senior Divisional Manager, M/s.United India Insurance Company Limited, No.6, Ganga Griha, Nungambakkam High Road, Chennai 600 034, to reimburse to the petitioner the balance amount of Rs.1,44,967/- incurred towards the petitioner's medical expenses with the third respondent Hospital within a time frame that may be stipulated by this Court.
For Petitioner : Mr.K.S.Govinda Prasad (Party-in-Person)
For Respondents: Mr.M.Danasegaran for R1 No appearance for R2 to R4
The Petitioner has taken an insurance policy from the First Respondent, viz., United India Insurance Company Limited for a sum of Rs.1,00,000/- for medical treatment. As per the terms of the policy, the hospitalization benefits for hernia hysterectomy would be the actual expenses or 25% of the sum insured, whichever is less. The Petitioner incurred an expenditure of a sum of Rs. 1,69,697/- and he was paid a sum of Rs.25,000.- by the First Respondent.
//True Copy//
Sub Assistant Registrar
To
2.The Insurance Ombudsman
For the State of Tamil Nadu and Puducherry,
Office of the Insurance Ombudsman,
Fathima Akhtar Court, 4th Floor,
453, Anna Salai, Teynampet,
Chennai 600 018.
+1cc to Mr.Govindaprasad, Advocate Sr.49534
+1cc to Mr.Venkatesan, Advocate Sr.48509
W.P. No.2931 of 2019
mg[co]
srg 25/07/2019
2 issues framed by the court
Whether the petitioner is eligible for reimbursement of the balance medical expenses claiming the lesser amount of Rs.25,000 was fully paid under the policy.
Whether the award passed by the Insurance Ombudsman should be quashed.
1 provisions across 1 enactments
K.S. Govinda Prasad
Union of India represented by The Senior Divisional Manager, M/s. United India Insurance Company Limited
The Insurance Ombudsman
M/s. Noble Hospital
M/s. Vipul Medcorp Insurance TPA Private Limited
P.D. AUDIKESAVALU
As recorded by the court registry
Judgements on the same questions, provisions and authorities, from every court
