Ashwini V REPORTABLE IN THE HIGH COURT OF JUDICATURE AT BOMBAY ORDINARY ORIGINAL CIVIL JURISDICTION WRIT PETITION NO. 2839 OF 2021 Rita Kirit Joshi, 3, Mihir, Patel Estate, Opp. Unichem Laboratories, Jogeshwari (West), Mumbai 400 102. …Petitioner ~ versus ~

1. NEW INDIA ASSURANCE COMPANY, Having its Head Office at

87, M.G. Road, Mumbai 400 001 & Also Registered Office at Dadar Divisional Office – II 14200, ‘B’ Ratan Central, 1st Floor, Plot – CS 777/778, Dr Babasaheb Ambedkar Road, Parel (East), Mumbai 400 012.

Email : nia.14200@newindia.co.in

2. M.D. India Health InsuRANCE, TPA Pvt Ltd, Mumbai Branch, Mezzanine Floor, Ballard House, Adi Marzban Path, Ballard Estate, CTS No. 1185, Fort, Mumbai 400 001 & at S.No. 46/1, E – Space, A-2 Building, 3rd Floor, Pune – Nagar Road, Vadgaonsheri, Pune 411 014.

3. The Insurance Regulatory And Development Authority Of India, Mumbai Regional Office, Royal Insurance Bldg., 12, J. Tata Road, Ground Floor, Mumbai 400 020. …Respondents APPEARANCES for the petitioner Mr Ashok Shetty, with Swapnil P Kamble.

for respondent no.1 Mr DS Joshi for respondent no. 3 Ms Komal B Shah, i/b Bhave & Co.

CORAM : G.S.Patel &

Neela Gokhale, JJ.

RESERVED ON : 10th February 2023 PRONOUNCED ON : 1st March 2023 JUDGMENT ( Per Neela Gokhale J) :-

1. Rule. Rule made returnable forthwith. Heard the Writ Petition finally on merits with the consent of the Learned counsel appearing for the Petitioner and the Respondent Nos. 1 and 3.

Though served, Respondent No. 2 is absent.

2. The present petition under Article 226 of the Constitution of India seeks a declaration that under Clause No. 3.11 of a particular insurance policy, the Petitioner is entitled to a recovery of all the expenses she incurred for the treatment of her new-born twin babies. She seeks a mandamus to the Respondent No. 1 insurance company to disburse the amounts of her claim. The prayers in the amended writ petition read thus:

“A. That this Hon'ble Court be pleased to issue a writ of Mandamus or Certiorari or any other appropriate writ, order or direction in the nature of a writ of Mandamus or Certiorari or any appropriate writ, order or direction under Articles 226 r/w Articles 14 & 21 of the Constitution of India, to hold and declare that under Clause 3.11 of the Mediclaim policies bearing Nos.: 14220034179500003932 & 1422003417780000676, the Petitioner would be entitled to all the expenses incurred by her for the treatment of her new born twin babies in terms of her claims amounting to Rs. 11,05,593/-; AND may further be pleased to quash and set aside the impugned communication dated Nil (which is at EXHIBIT - "H" to the petition) and the rejection / non acceptance of her claims under her Mediclaim Policies; AND further direct the Respondent No. 1 to reimburse the total expenses/claims submitted by the Petitioner for treatment of her twin babies under the Mediclaim policies bearing Nos.: 14220034179500003932 & 14220034177800 00676 amounting to Rs.11,05,593/- along with interest @ 18% from the date of refusal i.e. December–2018 till the date of actual payment to the Petitioner.”

3. FACTUAL MATRIX A) In 2007, the Petitioner took Mediclaim Policies Nos.

14220034179500003932 and 14220034177800003932 for Rs. 20 Lakhs from the Respondent No. 1 in the year 2007. These policies were renewed periodically.

The Petitioner regularly paid the premia.

B) On 3rd September 2018, the Petitioner delivered twin baby boys at 30 weeks’ gestation in an Emergency Lower Segment Caesarean Section (LSCS). Since the babies were premature, they had to be admitted to the Neo Natal Intensive Care Unit (NICU) at Surya Hospital for life-saving treatment. After their discharge from the hospital, the Petitioner submitted a claim to the 1st Respondent under the insurance policies claiming the expenses she had incurred at the NICU for the twins. For Twin Baby 1, the claim was Rs. 5,55,378/-. For Twin Baby 2, it was Rs. 5,52,565/-. The aggregate claim was Rs. 11,05,953/-.

C) Vide its undated letter, a co