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IN THE HIGH COURT OF KERALA AT ERNAKULAM
A. MUHAMED MUSTAQUE, SHOBA ANNAMMA EAPEN
N.S. Gopakumar, S/o. Late Sreekumar – Appellant
Versus
Oriental Insurance Company Ltd., Represented By Its Regional Manager – Respondent
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 ann
The Insurance Ombudsman can only award compensation under regulatory rules and lacks authority to mandate policy issuance at prior premiums.
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 Insurance Ombudsman acted within jurisdiction, and the Insurance Company must comply with the award, emphasizing accountability for delays and suppression of documents.
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 affirmed the Ombudsman's discretion to grant ex gratia payments in life insurance cases, considering social obligations and compassionate grounds despite policy lapses.
A lapsed insurance policy cannot be revived post-death, and the Insurance Ombudsman lacks authority to bypass contract terms based on equity.
The Insurance Ombudsman lacks jurisdiction to adjudicate complaints concerning policies from proprietorships or commercial lines, as these do not fall under personal lines as defined by relevant rule....
The main legal point established in the judgment is that a Partnership Firm cannot prefer a complaint under Rule 13 of the Redressal of Public Grievances Rules, 1998.
The court established that the principles of natural justice require that an employer, as a stakeholder in insurance claims, must be given an opportunity to be heard in proceedings before the Insuran....
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