Entitlement to insurance benefits based on hospitalization for more than 72 hours due to Covid-19

JUDGMENT

1. In S.B. Civil Writ Petition No. 11179/2021:-

2. The matter comes up on an application (2/2022) filed by the respondent seeking vacation of ex parte interim order dated 27.10.2021.

3. Learned counsel for the respondent submits that her claim was rejected by the petitioner-Insurance Company in an illegal manner travelling beyond the terms of insurance policy issued to her. Inviting attention of this Court towards the award dated 22.06.2021 passed by the Insurance Ombudsman, learned counsel submits that it is based on appreciation of the evidence on record and suffers from no perversity. He submits that from the documents placed by her on record alongwith her reply, it is established that she was admitted in the hospital for a period of more than 72 hours on account of being inflicted with Covid-19 and hence, was entitled for the insured sum. He, therefore, prays that the application be allowed and interim order of this Court dated 27.10.2021 be vacated.

4. Per contra, learned counsel for the petitioner submits that its investigator has, after thorough investigation, found the claim of the respondent to be false. He submits that in identical cases, the Insurance Ombudsman has dismissed the complaints. He, however, did not dispute that the documents appended with the reply were part of claim form submitted by the respondent with it. He, therefore, prays for dismissal of the application.

5. Heard. Considered.

6. As per the findings recorded by the Insurance Ombudsman in the award impugned dated 22.06.2021, the respondent was inflicted with Covid-19 infection and remained hospitalized for a continuous period of more than 72 hours. It has also been observed therein that it was not disputed by the Insurance Company that RT-PCR test of the respondent conducted by the Medical Department, Government of Rajasthan, substantiated infliction of the respondent with Covid-19. From the medical documents appended by the respondent alongwith her reply, this Court is prima facie satisfied that the respondent was suffering from Covid-19 and remained hospitalized.

7. In view of the aforesaid, this Court deems it just and proper to partly allow the application. The order dated 27.10.2021 is modified and it is directed that the petitioner shall pay to the respondent 50% of the award amount alongwith interest within a period of four weeks from today on her furnishing an undertaking to refund the same alongwith interest admissible in case the writ petition succeeds.

8. In S.B. Civil Writ Petition No. 11180/2021:-

9. The matter comes up on an application (2/2022) filed by the respondents seeking vacation of ex parte interim order dated 27.10.2021.

10. Learned counsel for the respondents submits that their claim was rejected by the petitioner-Insurance Company in an illegal manner travelling beyond the terms of insurance policy issued to them. Inviting attention of this Court towards the award dated 22.06.2021 passed by the Insurance Ombudsman, learned counsel submits that it is based on appreciation of the evidence on record and suffers from no perversity. He submits that from the documents placed by them on record alongwith their reply, it is established that they were admitted in the hospital for a period of more than 72 hours on account of being inflicted with Covid-19 and hence, were entitled for the insured sum. He, therefore, prays that the application be allowed and interim order of this Court dated 27.10.2021 be vacated.

11. Per contra, learned counsel for the petitioner submits that its investigator has, after thorough investigation, found the claim of the respondents to be false. He submits that in identical cases, the Insurance Ombudsman has dismissed the complaints. He, however, did not dispute that the documents appended with the reply were part of claim form submitted by the respondents with it. He, therefore, prays for dismissal of the application.

12. Heard. Considered.

13. As per the findings recorded by the Insurance Ombudsman in the awa