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2024 Supreme(Online)(KER) 19679
HIGH COURT OF KERALA
T. R. Ravi, J
ABDULLA @ OTTUR RAVINDRANATHAN – Appellant
Versus
THE MANAGER – Respondent
WP(C) 8360/2022
SRI C.K.RAMAKRISHNAN, SRI JITHIN SAJI ISAAC, SRI N.KRISHNA PRASAD, SRI BHARATH MOHAN, SRI K.J.SAJI ISAAC(S-82), MS. ELIZABETH VARKEY(E-25), SRI AJEESH EMMANUEL(K/109/2012), SRI SHAMSUDEEN O.K.(K/000687/2017)
The court established that the Insurance Ombudsman must assess claims fairly, especially when prior decisions by insurers are contested.
Headnote:
[Insurance] - [Writ Petition for Refund of Premium] - [Article 226] - [The court directed the Insurance Ombudsman to consider the petitioner's applications on merits, emphasizing the need for a fair hearing after the insurer's rejection of the claim due to policy lapse and non-payment of premiums.]
Fact of the Case:
The petitioner sought a refund of ₹1,00,000 paid as premium for an insurance policy taken in 2008, which lapsed due to non-payment of further premiums. The petitioner approached various grievance redressal bodies without success, leading to the writ petition.
Finding of the Court:
The court found that the Insurance Ombudsman had not considered the merits of the case and directed it to do so, allowing the petitioner to submit additional representations.
Issues: Whether the Insurance Ombudsman should consider the petitioner's claim for a refund of the premium paid for a lapsed insurance policy.
Ratio Decidendi: The court held that the Insurance Ombudsman must evaluate the petitioner's claim on its merits, as the insurer had already rejected the request without proper consideration.
Final Decision: The writ petition was disposed of with directions to the Insurance Ombudsman to consider the applications on merits.
The petitioner had taken an insurance policy from the first respondent and paid a sum of ₹1,00,000/- towards the first instalment of premium. This was done on 25.10.2008. He did not pay any further premiums. The policy was of 15 years duration.
The writ petition was filed 14 years later seeking a refund of the amount given as premium. Pending the writ petition, the petitioner wrongly approached the Banking Ombudsman for remedy. The Banking Ombudsman and the General Manager, Consumer Affairs Department, of the Grievance Cell of IRDAI were made additional respondents 2 and 3 in the writ petition. The second respondent replied stating that the first respondent does not come within the purview of the second respondent. Thereafter, the Insurance Ombudsman was impleaded as the additional fourth respondent. The petitioner submitted a complaint before the additional 4th respondent and the same has been rejected as per Ext.P8, stating that the petitioner has to represent his case first to the insurer, and it is only if he is not satisfied with the decision of the insurer that he can approach the Ombudsman. Exhibit P8 is dated 7.10.2022. The petitioner appears to have approached the additional 4th respondent again, by submitting Exts.P9 and P10 representations, but the same have not been considered so far on merits. The petitioner hence seeks relief under Article 226 of the Constitution of India .
2.The first respondent has filed a counter affidavit stating that the petitioner is not entitled to any relief since the policy which he had taken in 2008, has lapsed due to non-payment of instalments of premium. It is stated that if there is a default in the payment of the 2nd instalment, then the entire amount paid will get forfeited, and no amount will be payable under the surrender policy after one year. I do not propose to go into the merits of the contentions of the parties since the Insurance Ombudsman has not considered the issue on merits and has rejected the claim, stating that the petitioner has to first approach the insurer. The Insurance Ombudsman has not considered the fact that the petitioner had already approached the Insurer and the Insurer had rejected the request. In the circumstances, it is only appropriate that the Insurance Ombudsman considers the issue on merits and passes an order in accordance with the law.
3.The writ petition is hence disposed of directing the additional 4th respondent to consider Exts.P9 and P10 applications submitted by the petitioner and take a decision on merits, after hearing the petitioner and the 1st respondent, at the earliest, at any rate within four months from the date of receipt of a certified copy of this judgment. The petitioner shall be permitted to make additional written submissions, before the additional 4 th respondent, and the same shall also be accepted and considered by the additional 4th respondent in accordance with the law.
