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2025 Supreme(Online)(Bom) 6709

IN THE HIGH COURT OF JUDICATURE AT BOMBAY
SANDEEP V. MARNE, J
TATA AIG General Insurance Co. Ltd. – Appellant
Versus
Vinay Sah, Insurance Ombudsman, Pune (state of Maharashtra except Mumbai Metro) – Respondent


Advocates:
For the Appellants/Petitioners: Ms. Maithili Parikh, Mr. Nabeel Malik, Ms. Sanjana Sapra
For the Respondents: Mr. Avinash Fatangare, Ms. Archana Shelar

Table of Content
1. overview of insurance claim dispute. (Para 1 , 2 , 3 , 4)
2. arguments regarding insurance policy terms. (Para 6 , 7 , 9 , 21)
3. court's assessment of claim validity. (Para 10 , 11 , 12)
4. conflicting medical opinions analyzed. (Para 18 , 19 , 20)
5. legal interpretation standards applied. (Para 24 , 25)
6. final court decision and directive. (Para 28 , 29)

JUDGMENT :

1) This an unfortunate case, where all three male members of the family passed away in a short span of 6 months leaving behind the family in penury. The widow’s claim towards insurance availed by her husband as a part of package of housing loan availed for purchase of their home, is repudiated by the Petitioner insurance company. Due to widow’s inability to repay the housing loan, the finance company has attached the flat for sale. The Insurance Ombudsman has allowed the claim preferred by the widow and has directed Petitioner to pay to her the claim amount of Rs.27,00,000/- vide impugned award dated 21 November 2022. Petitioner is aggrieved by the award dated 21 November 2022 and has filed the present petition.

2) Brief facts of the case are that Respondent No. 2 and her late husband dreamt of owning a h

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