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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
| Table of Content |
|---|
| 1. invocation of article 226 of the constitution (Para 1 , 2 , 3 , 4) |
| 2. factual background of the accident and insurance claim (Para 5 , 6 , 7 , 8) |
| 3. petitioner's dissatisfaction with the insurance ombudsman (Para 9 , 10) |
| 4. arguments of the petitioner and respondent regarding misrepresentation (Para 12 , 13 , 14) |
| 5. overview of the insurance ombudsman’s functions and powers (Para 15 , 16 , 19) |
| 6. consideration of evidence and witness testimonies (Para 22 , 23 , 24 , 25) |
| 7. admissibility of electronic evidence in quasi-judicial proceedings (Para 26 , 27 , 28 , 29) |
| 8. implications of using inadmissible evidence (Para 30 , 31 , 32) |
| 9. court's decision to set aside the ombudsman's award (Para 34 , 35 , 36) |
| 10. directions for further proceedings and costs (Para 37 , 38 , 39) |
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
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.
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