The term '(A)ny person' in Rule 13(1) of the Insurance Ombudsman (Complaints) Rules, 1998 should be interpreted in a wide sense to include a company, as it is not repugnant to the context.

1. An interesting question arises for examination by this Bench on this writ petition, i.e. whether repudiation of an insurance claim by an insurer could be made the subject matter of a complaint before the Insurance Ombudsman (hereafter the ombudsman) under the Redressal of Public Grievances Rules, 1998 (hereafter the Rules) at the instance of a company incorporated under the Companies Act 1956.

2. The petitioning company’s claim having been repudiated by the insurer (respondent no. 4), a complaint was lodged before the ombudsman whereupon it was conveyed by the office of the ombudsman (respondent no. 3) by a communication dated February 5, 2015 that the ombudsman entertains complaints in respect of ‘insurance policies issued or purchased in an individual capacity, i.e. personal lines insurances only can be considered’. The petitioning company was, accordingly, advised to take up the matter with the insurer or any other Court/forum for resolution of its grievance. This order is the subject matter of challenge in this writ petition.

3. Referring to the provisions of the Rules, Ms. Shaw, learned advocate for the petitioning company, duly assisted by Ms. Agarwal, learned advocate contended that the respondent no. 3 was in error in holding that a complaint before it against an insurer could only be filed by an individual and not by a company. Reliance was placed on the decision of a learned single judge of the Madhya Pradesh High Court (Indore Bench) reported in [2010 160 COMP CAS 410 (MP) : Oriental Insurance Company Limited v. Ruchi Worldwide Limited], wherein it was held that a complaint at the instance of a company could be entertained by the ombudsman under the Rules. It was pointed out to this Bench that a different view had earlier been taken by a Division Bench of the Kerala High Court in the decision reported in 2005 (4) KLT 391 : National Insurance Co. Limited v. Indus Motor Co (P) Ltd.; however, the learned Judge while deciding Ruchi Worldwide (supra) had duly considered the decision in Indus Motor (supra) and given detailed reasons for recording disagreement therewith. It was urged that the view expressed in Ruchi Worldwide (surpa) is the correct view and that discarding the view expressed in Indus Motor Co (supra), this Bench ought to set aside the impugned communication and direct the respondent no. 3 to place the complaint before the ombudsman for consideration in accordance with law.

4. Mr. Mukerji, learned advocate representing the respondent no. 3 contended that the Rules have been framed for expeditious disposal of complaints lodged by individuals aggrieved by total or partial repudiation of insurance claims by insurers and such rules do not conceive of examination of complaints lodged by companies aggrieved by such repudiation. Rules 4(i), 4(j), 12 and 13 of the Rules were referred to by him to persuade this Bench to uphold the impugned communication.

5. Mr. Mukerji next referred to the meaning of the word ‘ombudsman’ by seeking to trace its meaning from the Concise Oxford Dictionary. He urged that having regard to the object sought to be achieved by framing the Rules, it would be clear that a complaint relating to settlement of insurance claims made only by a particular category of persons (individuals and their nominee/legal heir) could be entertained. The words ‘through its legal heirs’ were emphasized by him to drive home the point that the Rules are intended to provide a cost effective machinery for individuals to have their disputes settled by the ombudsman and the framers had deliberately not made any reference to ‘policy holder’ as defined in section 2(2) of the Insurance Act, 1938 (hereafter the 1938 Act) but had instead used the words ‘insured persons’ and ‘personal line’ which brings out the specific intention of opening the avenue for approaching the ombudsman to an ‘insured person’ and not ‘policy holder’.

6. Referring to rules 4(i) and (k), where the terms were sought to be explained by refe