Pavan Sachdeva vs Office of the Insurance Ombudsman

Judicial Analysis Court Copy Headnote Facts Arguments Court observation

DELHI HIGH COURT
NAVIN CHAWLA
Pavan Sachdeva – Appellant
Versus
Office of the Insurance Ombudsman – Respondent

Table of Content
1. petition challenges rejection of insurance claim. (Para 1 , 2 , 6)
2. petitioner provides medical history and claim denial details. (Para 3 , 4 , 5)
3. arguments on clause interpretation and alternate remedy. (Para 7 , 8 , 20)
4. principle of utmost good faith in insurance contracts. (Para 9 , 10 , 11 , 12 , 13 , 14)
5. disclosure requirements in insurance applications. (Para 18 , 21 , 22)
6. court finds ombudsman misinterpreted medical history. (Para 25 , 27)
7. court orders payment of claim with interest. (Para 30 , 31)

JUDGMENT

1. This petition has been filed by the petitioner inter alia challenging the order dated 21.02.2019 passed by the respondent no. 1 whereby the complaint of the petitioner against the rejection of his claim under the "Cigna TTK Health Insurance Family Policy" (hereinafter referred to as the "Policy") taken by him was rejected and the decision of the respondent no. 2 was upheld.

2. It is the case of the petitioner that the petitioner had obtained the abovementioned Policy from the respondent no. 2 on 14.08.2017. On 16.09.2017, while undertaking his morning walk, the petitioner felt mild pain and visited Fortis Escort Hospital. On 23.09.2017,

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DELHI HIGH COURTNAVIN CHAWLAPavan Sachdeva – AppellantVersusOffice of the Insurance Ombudsman – Respondent

DELHI HIGH COURT
NAVIN CHAWLA
Pavan Sachdeva – Appellant
Versus
Office of the Insurance Ombudsman – Respondent