$~3 * IN THE HIGH COURT OF DELHI AT NEW DELHI % Date of decision: 20^th August, 2024 + W.P.(C) 10643/2024 KARAN TOMAR .....Petitioner Through: Mr. Ashutosh Lohia, Mr. Rohit Saraswat and Mr. Karan Sharma, Advs.

versus INSURANCE OMBUDSMAN & ANR. .....Respondents Through: Mr. Pankaj Gupta Adv. for respondent No.2.

CORAM:

HON'BLE MR. JUSTICE DHARMESH SHARMA DHARMESH SHARMA, J.(ORAL)

CM APPL. 43828/2024 (Ex.)

1. Allowed, subject to all just exceptions. 2. The application shall stand disposed of.

W.P.(C) 10643/2024

3. The petitioner is invoking the extra ordinary jurisdiction of this Court under Article 227 of the Constitution of India, 1950, assailing the impugned Award passed by the respondent No.1, i.e., Insurance Ombudsman dated 04.07.2022, as also a subsequent letter dated 02.03.2023 passed by respondent No.2, i.e. ICICI Lombard General Insurance Company Limited.

4. Learned counsel for the respondent No.2 is present on advance notice and he requests some time to seekinstructions.

5. Having heard the learned counsel for the petitioner, this Court Signature Not Verified Digitally Signed By:PRAMWOD.P. (C) 10643/2024 Page 1 of 5 finds that no instructions are required from the respondents and the present Writ Petition, which raises a question of law, can conveniently be disposed of by passing appropriate directions.

6. Shorn of unnecessary details, the petitioner, aged 42 years, subscribed to a Health Insurance Policy with Apollo Munich Health Insurance for two yearsand subsequently with respondent No.2 for one year, from 02.08.2020 to 01.08.2021. On 08.04.2021, he underwent a comprehensive health check-up at Medanta Hospital, Gurgaon, as he was feeling weak and sick, and was diagnosed with chronic kidney disease, leading to hospitalization for about 10 days. He submitted a request for cashless payment of medical expenses, which was rejected on the grounds of non-disclosure of his diabetes and hypertension at the time of taking the policy. He approached to the grievance department of the respondent No.2 on 14.04.2021 and 22.04.2021 but no positive response.

7. Thus, a complaint was lodged with the respondent No.1, who after notice to the respondent No.2 and recording their submissions passed the following order:

“At this stage, the Insurers state that they are willing to share within 2 days the documents basis which, they had declined the request for cashless and for renewal of the policy, and that they are willing to review the matter, if the Complainant submits the reimbursement claim along with the requisite documents. The Complainant accepts this offer. Thus an agreement of conciliation could be arrived at between the Complainant and the Insurers, which I consider as fair and reasonable for both the parties.

Award The complaint is resolved in terms of the agreement of conciliation arrived at between the Complainant and the Insurers. Accordingly, the Insurers shall share with the Complainant the documents basis which, they had declined the request for cashless and for renewal Signature Not Verified Digitally Signed By:PRAMWOD.P. (C) 10643/2024 Page 2 of 5 of the policy, within 2 days. Thereafter, the Complainant shall have the option of submitting the reimbursement claim along with the requisite documents, and the Insurers shall then review the claim as well as the issue of renewal of the policy and take a decision within the next 3 weeks.

Parties should implement this agreement within 30 days.”

8. The learned counsel for the petitioner has urged that the aforesaid award is couched as an „Award‟ but it is not an „Award‟. It was contended that a cryptic order was passed, stating that „requisite documents‟needed to be supplied to the Insurance Company, even though all the relevant documents had already been provided. Despite his efforts, including repeatedly approaching the authorities, his grievance remains unresolved. Furthermore, a letter dated 21.03.2023 was received, stating that there is no provision for review of the order under the Insura