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2023 Supreme(Telangana) 241

IN THE HIGH COURT FOR THE STATE OF TELANGANA AT HYDERABAD
UJJAL BHUYAN, N. TUKARAMJI, JJ.
N. Vijaya Laxmi - Petitioner
Versus
Insurance Regulatory and Development Authority of India and another - Respondents
W.P. No. 45471 of 2022
Decided On : 03-04-2023

Advocates Appeared:
For the Petitioner: Mr. Ramesh Vishwanathula.
For the Respondents: Mr. M.V. Suresh, Mr. Bathula Raj Kiran.

Headnote:

Constitution of India, 1950 - Article 226 - Insurance Ombudsman Rules, 2017 - Rule 14 to 16 - Advocates Act, 1961 - Section 30 - Insurance death claim - Insurance ombudsman - Petition seeking a declaration that Rule 14 of Insurance Ombudsman Rules, 2017 includes representation by advocates or representatives of insurer, legal heirs, nominee or assignee in any proceedings before insurance ombudsman - Held, Court find that complaint of petitioner is now pending in first stage i.e., from Rules 14 to 16 involving a mediation process - Court do not find any good reason to direct appearance of a lawyer in mediation process being undertaken by insurance ombudsman - Court do not know what would be outcome of mediation process, but, if and when Rule 17 comes into picture, certainly, petitioner would have right to be represented by her lawyer - Writ Petition disposed of.

ORDER :

Ujjal Bhuyan, J.

Heard Mr. Ramesh Vishwanathula, learned counsel for the petitioner; Mr. M.V. Suresh, learned counsel for respondent No.1; and Mr. Bathula Raj Kiran, learned counsel for respondent No.2.

2. This petition has been filed under Article 226 of the Constitution of India seeking a declaration that Rule 14 of the Insurance Ombudsman Rules, 2017 (briefly ‘the Insurance Ombudsman Rules’ hereinafter) includes representation by advocates or representatives of the insurer, legal heirs, nominee or assignee in any proceedings before the insurance ombudsman.

3. Petitioner before us is the widow of late N. Parvathalu, who had availed a loan of Rs.30 lakhs on 04.08.2021 from United Small Finance Bank Limited (briefly ‘the bank’ hereinafter) for his business purpose. While sanctioning the loan amount, the bank got the same insured with ICICI Prudential Life Insurance Company Limited (briefly ‘the insurer’ hereinafter). For this purpose, insurance premium of Rs.37,184.00 was deducted by the bank while releasing the loan amount. Thereafter, the insurer issued life insurance policy covering the death of the insured for a sum of Rs.30 lakhs and in this connection, policy certificate was issued.

4. It is stated that at the time of sanctioning of the loan, bank had included the name of the petitioner as a co-applicant for the purpose of securing the loan advanced; title deeds of the petitioner’s house property had to be deposited with the bank as collateral security for the loan availed of.

5. Unfortunately a week after availing the loan, petitioner’s husband developed medical complications on 18.08.2021 whereafter he had to be admitted in the Apollo Hospital at Hyderabad. The medical condition was detected as sudden brain rapture because of which the husband went into a state of coma and expired on 20.08.2021.

6. On the death of her husband, petitioner moved the insurer for processing the insurance death claim as per the insurance policy. A letter dated 31.03.2022 issued by the insurer was received by her on 28.06.2022 whereby the insurer had repudiated the claim of the petitioner. On legal advice, petitioner approached respondent No.2 i.e., the insurance ombudsman by filing an application under Rule 14(1) of the Insurance Ombudsman Rules. It is stated that being an illiterate person, her application was drafted by her counsel which was thereafter submitted in the office of the ombudsman. When personal hearing was scheduled on 20.12.2022, petitioner authorized her counsel to be present along with her and also to present her case before the ombudsman. However, office of the ombudsman orally informed the petitioner that lawyers or representatives are not allowed in proceedings before ombudsman as per Rule 14(1) of the Insurance Ombudsman Rules.

7. Contending that insurance ombudsman is a tribunal exercising judicial powers in respect of which Section 30 of the Advocates Act, 1961 would be applicable as it enables lawyers to appear before the insurance ombudsman as a matter of right, the present writ petition came to be filed seeking the relief as indicated above.

8. Respondent No.2 i.e., office of the insurance ombudsman has filed counter-affidavit through Smt. S. Nirmala Devi, Secretary, office of the insurance ombudsman, Hyderabad. Stand taken in the counter-affidavit is that the office of insurance ombudsman is a grievance redressal forum to redress the complaints of insured persons against insurance companies; it is not a tribunal. In this connection, reference has been made to Rule 13 of the Insurance Ombudsman Rules to contend that the ombudsman acts as a counsellor as well as a mediator. It is basically an alternative grievance redressal forum, which is cost-effective and impartial. It is contended that the Insurance Ombudsman Rules does not contemplate any provision for representation of a complainant by an advocate; insurance ombudsman is not vested with any judicial powers. Referring to Rule 14(1) of the Insurance Ombudsman Ru

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