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IN THE GAUHATI HIGH COURT (HIGH COURT OF ASSAM, NAGALAND, MIZORAM AND ARUNACHAL PRADESH) KOHIMA BENCH
MANISH CHOUDHURY
Ratul Borgohain, S/o- Late Kirti Chandra Borgohain – Appellant
Versus
Office of the Insurance Ombudsman – Respondent
JUDGMENT :
MANISH CHOUDHURY, J.
Invoking the extra-ordinary and discretionary jurisdiction under Article 226 of the Constitution of India, assail is made in this writ petition to an Award dated 31.03.2023 passed by the Insurance Ombudsman, Guwahati as well as to an Order dated 10.01.2023 passed by the respondent Chola MS General Insurance Company Limited.
2. By the Order dated 10.01.2023, the respondent Chola MS General Insurance Company Limited [hereinafter also referred to as ‘the Insurer’, at places, for easy reference] as the Insurer had repudiated a claim submitted by the petitioner as the Insured allegedly on the ground of deliberate and wilful misrepresentation on the part of the petitioner-Insured. By the Award dated 31.03.2023, the Insurance Ombudsman had treated the complaint lodged by the petitioner-Insured against the claim repudiation as ‘closed’.
3. The background facts which are necessary and relevant for adjudication of the issues raised and involved in the writ petition can be exposited, briefly, at first.
4. The petitioner is the registered owner of a vehicle, TATA Ultra LPT 1518 [Truck] bearing Registration no. AS-09/AC-7560 [hereinafter referred to as ‘the subject-ve
An Insurance Ombudsman must not rely on inadmissible evidence; doing so undermines the principle of fair adjudication required in quasi-judicial proceedings.
The court ruled that an insurance claim cannot be repudiated on misinterpretations of theft and abandonment, emphasizing the need for valid grounds for repudiation.
The burden of proof in insurance claims lies with the insurer to establish policy violations, and claims cannot be repudiated without substantial evidence supporting such breaches.
Insurance co-exists with membership for period of insurance benefit but coverage under insurance would be a direct liability of Insurance company.
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.
The court emphasized the need for proper justification and adherence to regulations in repudiating an insurance claim, and highlighted the importance of considering expert reports and providing reaso....
The court held that disputes regarding insurance claims involving factual determinations are not suitable for resolution under Article 226, necessitating civil proceedings or arbitration.
The central legal point established in the judgment is the duty of the State to act fairly in insurance contracts, the violation of which can lead to the setting aside of repudiated insurance claims.
A lapsed insurance policy cannot be revived post-death, and the Insurance Ombudsman lacks authority to bypass contract terms based on equity.
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