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HIGH COURT OF GUJARAT
MR. JUSTICE ANIRUDDHA P. MAYEE, J
HDFC ERGO GENERAL INSURANCE CO. LTD. – Appellant
Versus
TEJPAL B. CHAWLA – Respondent
JUDGMENT :
(ANIRUDDHA P. MAYEE, J.)
1. The present Special Civil Application has been filed by the petitioner insurance company praying for the following reliefs:-
“15A. Be pleased to admit and allow this petition.
B. The Hon'ble Court may be further pleased to consider that the judgment/award of the Ld. Insurance Ombudsman, Ahmedabad vide complaint No. AHD-G-018-2324-0025 dated 02/08/2023 (Annexure A) is illegal, wrong and be further be pleased to quash and set aside the impugned award and/or modify the same considering merits of the case.
C. As an ad-interim ex parte relief, the Hon'ble Court may stay the judgment/award of the Ld. Insurance Ombudsman, Ahmedabad vide complaint No. AHD-G-018-2324-0025 dated 02/08/2023 (Annexure A).
D. Be pleased to pass such other and further awards may be deemed just and proper looking to the facts and circumstances of the case and in the interest of the justice.
2. The brief facts of the case are that, the respondents had purchased the Sarva Suraksha Policy (Plus) for the period commencing from 08.06.2015 to 07.06.2020 [“1st policy” for the sake of brevity]. That the respondent No.1 lost his job on 15.12.2017 and thereafter lodged the claim with the p
Insurance policies allow multiple claims for loss of job until the sum insured is exhausted, subject to maximum payment limits.
The Ombudsman should not reject a claim based on the total value of the stock exceeding the limit if the claim amount is within the prescribed limit.
The court clarified that the monetary limit in the Insurance Ombudsman Rules applies to compensation, not to the claims themselves, allowing for broader jurisdiction.
The absence of a specific bar in the 2016 Regulations regarding the consideration of renewed policies for claim settlement and the need to protect the rights of policyholders.
The Insurance Ombudsman can only award compensation under regulatory rules and lacks authority to mandate policy issuance at prior premiums.
An insurance policy lapses if the premium is not paid within the grace period; revivals after the insured's death are impermissible under contract terms.
Insurer cannot raise unpleaded policy limit defence in appeal under Employees Compensation Act.
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