N.I.Co.Ltd. v. Insurance Ombudsman

W.P.(C) No.2005 of 2009

9.5.2017

Heard Mr. Gautam Mihsra, learned counsel for the petitioner and Mr. R.K. Mohanty, learned Seni
or Advocate appearing on behalf of opp. Party no.2.

2. Challenge has been made to the impugned order dated 25.7.2008 passed by the learned In
surance Ombudsman in Complaint No. 14-003-0275 (Annexure-5).

3. Mr. Mishra, learned counsel for the petitioner submits that the impugned order suffers
 from several infirmities. According to him, at paragraph-10 of the impugned order the learned
 Ombudsman has observed that the observations made by the surveyors may have some force to dou
bt the incident, but without any other materials, it cannot be said that it might be true and
thus, the Ombudsman has doubt in mind about the claim made by the insured. Drawing attention o
f the Court to paragraph-12 of the impugned order, he submits that the Ombudsman is also of th
e opinion that the complainant did not cooperate the investigating agency of the insurer which
 speaks volumes against the claim made by the complainant.

4. Learned counsel for the petitioner further submits that the death of the wife of the c
omplainant occurred due to suicide committed by her because the surveyor has reported as such.
 He further submits that the policy of the insured was personal accident individual policy and
 the condition of the same has not been compiled by the insured, for which the complainant has
 no right to claim the amount. He submits that the learned Ombudsman has lost sight of this fa
ct and passed the wrong order. According to him, the complainant should have made claim within
 a period of one month of death, but in the instant case it has been reported two months after
 her death.