IN THE HIGH COURT OF JUDICATURE AT MADRAS DATED: 27-03-2026 CORAM THE HON'BLE MR JUSTICE M.DHANDAPANI AND WMP NO. 13129 OF 2026,WMP NO. 13130 OF 2026 SBI General Insurance Company Ltd., Rep by its Authorised Signatory, T Block 8 Street, First Floor T 48 97, 3rd Avenue, Annanagar, Chennai-040. ..Petitioner(s)

Vs

1. The Insurance Ombudsman Office of the Insurance Ombudsman, Fathima Akhtar Court, 4th floor, 453 Anna Salai, Teynampet, Chennai-18.

2. A.Selestin No.7/778, North Street, Mandalakkottai, Keelakurichi, Pattukkottai, Thanjavur.

..Respondent(s)

Prayer: Writ Petition is filed under Article 226 of the Constitution of India praying for issuance of writ of Certiorari to call for the records relating to the award passed by the 1st Respondent with ref No.NO.IO /CHN/ A/ HI/ 1222/

2025- 2026 dated 23.02.2026 and quash the said award and pass.

For Petitioner(s): M/s.Srinath R Iyenkar

Order

This writ petition is filed challenging the impugned award passed by the

1^st respondent, settled the claim for 90% of the sum insured in favour of the 2^nd respondent.

2. Case of the petitioner is that the petitioner is a reputed company involved in the business of general insurance and offers a range of insurance products, including health, motor, travel, home and commercial insurance services throughout India. 1^st Respondent is the Insurance Ombudsman Office. The 2^nd respondent is enrolled under a Group Personal Accident Insurance Policy. The said policy provides coverage of Rs.20,00,000/- for the period commencing from 04.03.2023 to 02.03.2024. While so, on 18.05.2023, the 2^nd respondent met with a serious road traffic accident, as a result of which he sustained multiple cervical fractures, injury to spinal cord in the cervical region and neurological damage and diagnosed with Traumatic Quadriplegia post- accident. The Government Institute of Rehabilitation Medicine, K.K.Nagar, Chennai, also issued Disability Certificate dated 28.11.2023 certified that the 2^nd respondent is suffering from 90% Locomotor Disability affecting all four limbs. Thereafter, the 2^nd respondent lodged a claim with the Petitioner Company seeking payment of a sum of Rs.20,00,000/- under the policy, alleging that he had suffered permanent disability due to the road accident. However, the claim was rejected on the ground that the disability claimed by the 2^nd respondent does not fall within the list of Permanent Total Disability covered under the Policy. Hence, the 2^nd respondent preferred a complaint before the 1^st respondent. The 1^st respondent vide an award dated 23.02.2026, directed the Petitioner to admit the claim and settle it for 90% of sum insured. Aggrieved by the impugned award, the petitioner is before this Court.

3. The learned counsel for the petitioner submitted that the 1^st respondent Ombudsman ignored the exhaustive and exclusive definition of ‘’Loss’’ under the Policy. The coverage, benefits, definition and exclusion under one policy cannot be compared with or substituted by the terms of another policy, even if issued by the same insurer. Hence, the 1^st respondent did not have the authority to award a claim that does not fall within the specified table of losses.

Therefore, the impugned Award is liable to be quashed.

4. Heard the learned counsel for the petitioner and also perused the materials available on record. Since no adverse orders are passed against the respondents, notice to them is not necessary and this Court is inclined to dispose the case based on available materials.

5. Facts in the present case is not in dispute that the 2^nd respondent has taken insurance policy with the petitioner Company and the said Insurance policy is in force and valid on the date of accident. As per the Disability Certificate, he was diagnosed with 90% Permanent Disability in relation to his all four limb and therefore, the 1^st respondent Ombudsman after carefully gone through the material records, had clearly come to the following conclusion, which is scanned and extracted hereu