The Insurance Ombudsman can only award compensation under regulatory rules and lacks authority to mandate policy issuance at prior premiums.

JUDGMENT :

SHOBA ANNAMMA EAPEN, J.

This intra court appeal is filed by the first respondent in WP(C) No.21288 of 2022, challenging the judgment dated 30.01.2023 of the learned Single Judge. The Oriental Insurance Co. Ltd., the first respondent herein, was the writ petitioner. The Insurance Ombudsman, the second respondent herein, was the second respondent in the writ petition.

2. The question involved in this case is whether the Insurance Ombudsman has power to direct the insurance company to issue a medi-claim policy at the same premium as was originally charged and to issue directions, directing payment of premium.

3. The facts of the case are as follows;

The appellant herein had taken a medi-claim policy from the respondent insurance company through the Punjab National Bank as per PNB-Oriental Royal Medi-claim policy from 09.12.2014 onwards. The policy was being renewed thereafter and the last period of policy was from 09.12.2017 to 08.12.2018. On 29.11.2018, when he approached the Punjab National Bank, Thrikkakara for renewal of policy from 08.12.2018, he was informed that the premium for renewing the policy is enhanced to ₹19,587/-. Originally, the premium was only ₹7,172/- per annum. Hence, objecting to the enhanced rate of premium, the appellant issued Ext.P1 notice to the respondent insurance company to renew the policy on the normal rate. In reply to that, the respondent insurance company issued Ext.P2, stating that the revision of premium is nominal considering the medical inflation that happened during the past years. He was further informed that the said premium was fixed after obtaining approval from the Regulator. Thereafter, a complaint dated 02.01.2019 was given by the appellant before the Grievance Cell of the respondent insurance company. In reply to that, Ext.P3 letter dated 03.01.2019 was issued to the appellant explaining the reasons for the enhancement of premium. However, instead of renewing the policy within the grace period, the appellant filed Ext.P5 complaint before the Insurance Ombudsman, which was dismissed as per Ext.P6 award dated 23.09.2019. Challenging this, the appellant had filed WP(C) No.29027 of 2019 and this Court, as per Ext.P7 judgment, set aside Ext.P6 award, directing the Insurance Ombudsman to reconsider Ext.P5 complaint after affording the appellant an opportunity of being heard. In compliance of Ext.P7 judgment, the Insurance Ombudsman passed Ext.P8 award, operative portion of which reads as follows:

“(1) The Respondent Insurer shall issue to the Complainant a policy covering himself and his eligible family members as per the PNB Oriental Royal Mediclaim policy for a Family Floater Sum Insured of Rs. 500,000 and at the same premium as was charged under policy No.440202/48/2015/3653 that expired on 08.12.2018.

(2) The new policy shall be issued for a period of one year with effect from the date of payment of premium by the Complainant and shall be for the same coverage as per the PNB Oriental Royal Mediclaim policy or the coverage that most closely approximates the PNB Oriental Royal Mediclaim coverage from among the policies currently offered by the Respondent Insurer. The new policy thus issued shall incorporate all "continuity benefits" as would have been available to the Complainant had his policy been renewed in the normal course from 09.12.2018.

(3) The Respondent Insurer shall be free to apply any duly approved premium revisions at the time of renewal of the new policy issued as per (1) and (2) above, subject to due advance notice sent to the policy-holder as per regulatory norms.”

Aggrieved by Ext.P8 award, the respondent insurance company filed the writ petition before this Court with the following prayers:

“i) to declare that the Insurance Ombudsman has no power to direct the Insurance company to issue a policy in 2022, accepting pre-revised premium of 2017.

ii) to set aside Exhibit P8 order to the extent it directs the petitioner to issue a Medi-Claim Policy at the same premium as w