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2026 Supreme(Online)(Mad) 25737
IN THE HIGH COURT OF JUDICATURE AT MADRAS
N.SATHISH KUMAR, M.JOTHIRAMAN, JJ
S.S.Vijay Rajesh – Appellant
Versus
The Insurance Ombudsman, For the State Tamil Nadu and Puducherry – Respondent
W.A(MD)No.407 of 2026 | W.P(MD)No.25560 of 2023
For Appellant : Mr.R.Velmurugan
Writ jurisdiction inappropriate for disputed factual issues like accident causation; pursue civil suit or Consumer Forum.
Headnote:The writ petitioner, son of the insured under a Personal Accident Insurance Policy, claimed Rs.20,00,000/- following the insured's death allegedly due to a slip and fall causing head injury and hemorrhagic contusions, as per CT scan. The insurer repudiated the claim citing natural causes (acute pulmonary edema and heart failure), upheld by the Insurance Ombudsman and Single Judge upon review of medical records lacking conclusive evidence of accident. Court held no merit in appeal. Issue: Whether medical records conclusively establish accidental death entitling claim under policy. Ratio: In writ proceedings, disputed questions of fact regarding causation cannot be adjudicated; claimant must prove accident via evidence in civil suit or Consumer Forum, not writ jurisdiction. (paras 6) Writ appeal dismissed; liberty granted to file suit or Consumer Forum complaint; limitation period excluded for prior proceedings.
| Table of Content |
|---|
| 1. claim rejection for accidental death due to lack of evidence (Para 1 , 2 , 3 , 4) |
| 2. writ court cannot resolve disputed facts (Para 6) |
| 3. appeal dismissed with liberty to file suit (Para 7) |
[Judgment of the Court was made by N.SATHISH KUMAR, J.)
Challenging the order of the learned Single Judge dismissing the writ petition in W.P.(MD) No.25560 of 2023 dated 18.11.2025, the present writ appeal has been filed.
2. The appellant/writ petitioner filed the writ petition seeking to quash the order of the first respondent dated 31.05.2023, whereby the petitioner’s claim for personal accident insurance amounting to Rs.20,00,000/- was rejected. The writ petitioner is the son of the deceased, one V. Shantha. According to him, his mother was covered under a Personal Accident Insurance Policy bearing No. 31016502, valid up to 24.10.2023. On 31.10.2022, she allegedly suffered an accidental slip and fall in the bathroom of her residence, resulting in head injury and bodily trauma, and was admitted to Velammal Medical College Hospital and Research Institute. Later, she succumbed to the injuries. It is further stated that she was under continuous treatment and that a CT Brain scan conducted at Government Rajaji Hospital revealed hemorrhagic contusions and a depressed fracture. Therefore, according to the petitioner, the death was due to the accidental fall in the bathroom and, hence, he is entitled to the insurance amount.
3. The claim was repudiated on the ground that the insured died due to natural causes, namely acute pulmonary edema and heart failure. Thereafter, the petitioner lodged a complaint before the Insurance Ombudsman, which also came to be rejected by an award dated 31.05.2023. Challenging the same, the writ petition was filed.
4. The learned Single Judge, on a perusal of the medical records, found that the records only indicated the nature of death and that there was no conclusive evidence to establish that the death was accidental in nature. Accordingly, the writ petition was dismissed.
5. We have heard both sides and perused the materials available on record.
6. Though it is contended that the insured was continuously taking treatment and that her death occurred only due to the accidental trauma suffered in the fall, we are of the view that when the medical records indicate otherwise, it is for the appellant to establish, by proper evidence, that the death was caused by an accident. Such an exercise can only be undertaken in appropriate proceedings and not in a writ petition. If the petitioner intends to establish the same, he ought to have filed a civil suit or a complaint before the Consumer Forum. In a writ petition, such compensation cannot be granted when disputed questions of fact are involved.
7. We find no merit in the writ appeal and, accordingly, the writ appeal stands dismissed. However, liberty is granted to the petitioner to file an appropriate suit or a complaint before the Consumer Forum, in accordance with law, and establish his case. No costs.
