Digitally signed by LAXMIKANT LAXMIKANT GOPAL GOPAL CHANDAN CHANDAN Date:

2024.12.10

17:34:38 +0530 lgc IN THE HIGH COURT OF JUDICATURE AT BOMBAY ORDINARY ORIGINAL CIVIL JURISDICTION WRIT PETITION NO. 2903 OF 2021 Bharat Hirji Dedhia, ] Through his attorney namely ] Mr. Rahul Dedhia ] Age:68 Years, having address at B-1204, ] Bhavya Heights CHSL, Katrak Road, ]

Wadala (W), Mumbai - 400031 ] …Petitioner VERSUS

1. Union of India, ]

represented by the Secretary ] for Ministry of Finance having its ] address at New India Assurance ] Building, 87, M. G. Road, Fort, ] Mumbai - 400001 ]

]

2. The Oriental Insurance Company Ltd. ]

A public limited Company, having its ] office at Maker Bhawan No.1, 5^th Floor, ] New Marine Lines, Churchgate ]

Mumbai – 40020 ] …Respondents WITH WRIT PETITION NO. 706 OF 2024 Oriental Insurance Co. Ltd., ] Manger, Mumbai Regional Office 1, ] Oriental House, 2^nd floor, 7, J. Tata Road ]

Churchgate, Mumbai -400020 ] …Petitioner VERSUS

1. Office of Insurance Ombudsman, ]

Jeevan Seva Annexe, 3^rd floor, S.V. ] Road, Santacruz (W), Mumbai-54 ]

]

2. Bharat H Dedhia ]

Aged 68 years, Occupation : nil ] B-1204, Bhavya Heights CHS, Katrak ] Road, Near Ram Mandir, Wadala-(W) ]

Mumbai – 400 031 ]…Respondents WITH INTERIM APPLICATION NO.424 OF 2022 IN WRIT PETITION NO. 706 OF 2024 Oriental Insurance Co. Ltd. ]...Applicant In the matter between Oriental Insurance Co. Ltd. ]...Petitioner Versus Office of Insurance Ombudsman and anr. ]...Respondents __________________________________________________________

APPEARANCES-

Mr Aseem Naphade, a/w Ms Nishtha Malik, Ms Sonali Kochar, Ms Bijal Soni, Mr Tejas Horambe, i/b. NAS Legal Advocates, for the Petitioner in WP/2903/2021 and for Respondent No.2 in WP/706/2024.

Ms S. S. Dwivedi, for the Petitioner in WP/706/2024 and for Respondent No.2 in WP/2903/2021, and for the Applicant.

Ms Karuna Yadav, h/f Mr Parag A. Vyas, for the Respondent-Union of India in WP/2903/2021.

__________________________________________________________

CORAM : M.S.Sonak &

Jitendra Jain, JJ.

RESERVED ON : 06 December 2024 PRONOUNCED ON : 09 December 2024 JUDGMENT ( P er MS Sonak J) :-

1. Heard learned counsel for the parties. Rule in both these Petitions. The Rule is made returnable immediately at the request of and with the consent of the learned counsel for the parties.

2. Interim Application No.424 of 2022 seeking leave to amend Writ Petition No.706 of 2024 is allowed. Amendment to be carried out immediately. Reverification is dispensed with.

3. Learned counsel for the parties agree that a common order can dispose of both these Petitions. In any event, Writ Petition No.2903 of 2021 seeks to implement the Insurance Ombudsman’s award dated 03 May 2021 and Writ Petition No.706 of 2024 questions the same award dated 03 May 2021.

4. The learned counsel for the parties submitted that Writ Petition No.706 of 2024 be considered first because the fate of Writ Petition No.2903 of 2021 would depend upon the decision in Writ Petition No.706 of 2024. This is correct, and the suggestion of the learned counsel for the parties is accepted.

5. In Writ Petition No.706 of 2024, the Oriental Insurance Company Limited (“Insurance Company”) challenges the Insurance Ombudsman’s award dated 03 May 2021, directing the Insurance Company to pay to Bharat Dedhia (the second Respondent and the Petitioner in Writ Petition No.2903 of 2021) an amount of Rs.27,13,582/- against the health insurance policy taken by Bharat Dedhia (“Bharat”) from the Insurance Company.

6. Ms Dwivedi, the learned counsel for the Insurance Company, submitted that the Ombudsman exceeded the scope of its jurisdiction in making the impugned award. Therefore, she submitted that the award is illegal, arbitrary, unconstitutional, and without jurisdiction.

7. Ms Dwivedi submitted that Bharat had submitted a proposal form (self-declaration form) based upon which the health insurance policies or at least the additional health insurance policies were issued to Bharat. She submitted that in this propo